By Ana Espino | Published on July 30, 2025 | 2 min read
#HCV #Hepatitis #Pancreas
Pancreatic transplantation remains
an effective solution for patients with severe type 1 diabetes, but the number
of available grafts is still insufficient. In response to this shortage, grafts
from donors infected with the hepatitis C virus (HCV) represent an
underutilized resource. Historically, transmission of the virus to seronegative
recipients (D+/R−) was prohibitive due to infectious risks and the limitations
of treatments available at the time (interferon ± ribavirin). The introduction
of direct-acting antivirals (DAAs), effective across all genotypes and well
tolerated, has changed this perception. In liver and kidney transplants, the
outcomes of D+/R− grafts under DAA treatment are very encouraging. However,
data on D+/R− pancreatic transplantation remain scarce.
In this context, this study was
initiated to
explore the available clinical data on pancreatic transplantation
from HCV-viremic donors to seronegative recipients and to evaluate the efficacy
of prophylactic or reactive DAA treatment regimens.
Transplanting an infected pancreas…
could it be safe?
Seven studies published between 2020
and 2025 were analyzed, encompassing 22
patients who received pancreatic grafts
from HCV-viremic donors to seronegative recipients (D+/R−), either as a
stand-alone procedure or combined with a kidney transplant. The patients
received various direct-acting antiviral (DAA) protocols, administered either
prophylactically—before or immediately after transplantation—or
reactively,
after confirmation of viral infection.
The study results are particularly
encouraging. All patients achieved a
sustained virologic response at 12 weeks
(SVR12), regardless of the antiviral regimen used.
Graft function, whether
pancreatic or renal, was
preserved, and
no cases of acute pancreatic rejection
were reported.
DAA treatments were well tolerated, including in patients under
strong immunosuppression. Short
prophylactic protocols (7 to 8 days) proved to
be as effective as standard 12-week reactive strategies.
Only one case of
initial virologic failure was reported, related to an antiviral regimen that
was inappropriate for the viral genotype; this was successfully corrected with
a 16-week retreatment.
Could the virus open new doors?
Pancreatic transplantation is an
effective therapeutic option but is limited by the
shortage of grafts. The use
of
pancreases from HCV-viremic donors, once excluded, is now a viable option
thanks to
direct-acting antivirals.
The main challenge lies in
ensuring
the safety of this approach for seronegative recipients by defining
appropriate
antiviral protocols and
rigorous post-transplant follow-up.
This review demonstrates that D+/R−
pancreatic transplants, when combined with properly managed antiviral
treatment, allow
complete eradication of the virus while preserving graft
function, with
no major complications.
The results are very promising. In
the long term, integrating HCV-positive grafts into clinical practice could
significantly reduce waiting times. This, however, requires the
development of
clear recommendations, appropriate patient selection, and an individualized
approach based on virological and immunological status.
Read next: Hepatitis C: 5-minute test, accurate results?
About the author – Ana EspinoPhD in Immunology, specialized in Virology
