*Purpose: Background: The field of organ transplantation continuously struggles with inadequate numbers of donor organs. Therefore, efforts remain focused on increasing organ utilization and expanding the donor pool. Transplant centers, UNOS, and SRTR have continued to explore increased organ utilization in the areas of PHS increased risk, high KDPI and most recently the use of organs exposed or infected with viral hepatitis—organs with historically higher discard rates. Organ acceptance starts at listing when designating whether a patient will take a HCV Ab+ and/or NAT+ organ. There is ongoing ambiguity surrounding the clinical impact on recipients when considering HCV Ab+/NAT- and HCV NAT+ donors, this ambiguity extends to calculating KDPI. Aims: (1) To determine if HCV Ab+/ NAT- donors result in recipient infection with HCV. (2) To determine if the risk of recipient infection varies across organ types in our multi-organ experience.

*Methods: A retrospective review was conducted on all transplant recipients from 2013-2018 at Vanderbilt Transplant Center who received HCV Ab+/NAT- grafts. All transplant recipients were not previously exposed to HCV at the time of listing. A total of 27 patients received an HCV Ab+/NAT- graft: 9 heart recipients, 3 kidney recipients, and 15 liver recipients.

*Results: Out of the 27 transplant recipients, no recipient developed infection with HCV post-transplant as evidenced by serial undetectable PCR testing. Table 1 outlines the number of post-transplant recipients who received PCR testing at the following testing intervals: first 3 months, 6 months, and 12 months.

*Conclusions: Our experience expands on the existing literature, adding multi-organ data on the use of HCV Ab+/NAT- grafts. The results of this study, suggest that the use of HCV Ab+/NAT- grafts carry no perceived additional risk of HCV infection to recipients. This raises the importance of educating transplant candidates and the community on acceptance of organ offers for HCV Ab+/NAT- to encourage utilization of these often-overlooked organs.

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