Direct-Acting Antivirals and Organ Transplantation: Is There Anything We Can't Do?

J Infect Dis. 2020 Nov 27;222(Suppl 9):S794-S801. doi: 10.1093/infdis/jiaa420.


The opioid epidemic has resulted in an increase in organ donors with hepatitis C virus (HCV) infection in the United States. With the development of direct-acting antiviral regimens that offer high sustained virologic response rates even in the setting of immunosuppression after transplantation, these HCV-viremic organs are now being offered to transplant candidates with or without preexisting HCV infection. Strategies for HCV treatment with HCV-viremic organs have included delayed and preemptive approaches. This review will discuss key studies in the different solid organ transplants, recent reports of adverse events, and ethical and regulatory considerations. The efficacy of current HCV therapies has created this important opportunity to improve survival for patients with end-organ failure through greater access to organ transplantation and decreased waitlist mortality rate.

Keywords: antiviral agents; donor selection; hepatitis C; organ transplantation.

MeSH terms

  • Antiviral Agents / therapeutic use*
  • Clinical Trials as Topic
  • Donor Selection
  • Hepatitis C / complications
  • Hepatitis C / drug therapy*
  • Humans
  • Immunocompromised Host
  • Organ Transplantation / adverse effects*
  • Tissue Donors / statistics & numerical data*
  • United States


  • Antiviral Agents