Emerging strategies in the transplantation of HCV-infected pancreases to uninfected recipients: A narrative review

The scarcity of suitable candidates for solid organ transplantation (SOT) represents a major barrier to the reduction of waiting lists. The introduction of direct-acting antiviral (DAA) therapeutics eliminates many of the risks associated with the transplantation of Hepatitis C Virus (HCV)-infected donor organs (D+) to uninfected recipients (R-) and may facilitate access to a substantial organ pool, previously considered unacceptably high risk. The extent of clinical investigation into the safety and feasibility of HCV D+/R- SOT varies between allograft types.

Here, we review the current state of pancreatic HCV D+/R-transplant research. Studies are limited to small cohorts who received pancreas allografts from HCV-viraemic donors alongside a regimen of DAA therapy. As of 2025, seven studies investigated a total of 22 patients, using prophylactic or reactive treatment regimens. Outcomes have been positive, with universal viral eradication, favourable allograft function, and minimal HCV-related complications. A favourable adverse event profile is reported, mirroring studies in other transplanted organs.

With the aim to increase clinical use of pancreatic HCV D+/R- SOT, further investigation in the field is necessary to validate these preliminary data. Larger studies are essential to evaluate long-term sequelae and optimise treatment protocols to subsequently establish a standard of care.