Table 1.

Current and future considerations for choosing recipients of HCV viremic kidney transplantation

Current Inclusion/Exclusion Criteria	Current Rationale	Recommendations/Future Direction
Age must be 40–70 years old	Patients < 40 years often have more opportunities for DDKT and have lower waitlist mortality. Participants > 70 years may not be acceptable LT candidates or may have increased perioperative mortality	Remove strict age cutoff, individualized decisions. The need to meet LT criteria may be too strict.
No available living kidney donor	Living kidney donor transplantation has survival advantages over DDKT	Continue to restrict participation to those with no available living donor
Has ≤ 2 years of accrued transplant waiting time if blood type A and ≤ 3 years of accrued transplant waiting time if blood type B or O. Excluded if blood types AB.	Those with longer accrued transplant waiting time would be less likely to benefit. Blood types B and O typically have significantly longer average waitlist times compared to blood type A. Patients with blood group AB often have shorter waiting times for KT and are less likely to benefit from this protocol.	No strict restrictions on waitlist time, shared decision-making with transplant team and patient, taking into account current practice patterns and likelihood of shortened waitlist time with participation.
On chronic hemodialysis or peritoneal dialysis or has eGFR <15mL/min/1.73m2 at the time of screening	Participants with eGFR <15 ml/min/m2 are more likely to be at risk of renal disease-related complications and higher risk of mortality than participant with eGFR 15–20 ml/min/m2.	Per center guidelines on timing of pre-emptive transplantation
Must agree to birth control, must not be pregnant or lactating.	Acute HCV infection or the use of study drug might carry risks to a pregnancy that must be avoided. Pregnancy in early post-transplant period should be avoided.	Pregnancy must be avoided
Considerations to decrease perioperative risk: - Weigh at least 50kg, BMI < 35, Albumin ≥ 3g/dL, platelet count ≥ 75 × 103/mL	Exclude patients who are at risk of peri and post-operative complications	Per center guidelines for standard KT
Serum ALT within normal limits with no history of liver disease	Patients must have no evidence of liver disease. This is in order to limit the risks of acute HCV infection on the liver.	Patients should be evaluated for liver disease and excluded from participation if it is detected
Able to sign informed consent	All patients must have a full understanding of the risk of participation. Surrogate consent is not allowed.	All patients must have a full understanding of the risk of participation. Surrogate consent is not allowed.
Sufficient cardiac function: LV ejection fraction > 50%	Patients should have adequate cardiac function to ensure LT candidacy.	Per center guidelines for standard KT. The need to meet LT criteria may be too strict.
Exclude patient who may need for non-standard post-transplant immunosuppression: 1) known allergy or intolerance to tacrolimus 2) Positive donor specific antibodies or positive cross-match deemed to be clinically significant 3) Patients with primary focal segmental glomerulosclerosis (FSGS), FSGS recurring after prior transplant, or disease process at increased risk of early graft failure	To minimize participant risks, we exclude participants who may need non-standard post-transplant immunosuppression or desensitization in order to minimize possible drug-drug interactions	Drug-drug interactions will continue to be a challenge
HIV-infected recipients	Participants with HIV may need medications with complex drug-drug interactions and are at increased risk of acute rejection.	Working with HIV specialists may allow for conversion of antiretroviral therapy regimen prior to transplant, allowing for safe participation of HIV-infected adults
Hepatitis B surface antigen positive	Patients with active Hepatitis B virus infection will be excluded in order to limit the risks of acute HCV infection on the liver.	Recommend excluding patients with active Hepatitis B infection

Abbreviations: ALT, alanine aminotransferase; BMI, body-mass index; DDKT, deceased donor kidney transplant; eGFR, estimated glomerular filtration rate; FSGS, focal segmental glomerulosclerosis; HCV, hepatitis C virus infection; HIV, human immunodeficiency; KT, kidney transplant; LV, left ventricular; RNA, ribonucleic acid.