*Purpose: Development of direct acting anti-viral medications (DAA) have offered cure rates for hepatitis C infection (HCV) approaching 100%. This has provided the ability to transplant HCV positive kidneys into noninfected recipients.

*Methods: Forty HCV negative patients who received HCV NAT positive kidneys (D+/R-) were age matched to 40 HCV negative patients who received non-infected kidneys (D-/R-). Post-operative complications and graft function were compared. D+/R- patients were monitored post-operatively for development of viremia and subsequently treated with DAAs.

*Results: The D-/R- group were age matched to the D+/R- group (64.9 vs 66.9 years, p=0.02). The mean donor age was higher in the D-/R- group (43.3 vs 35.1, p=0.01). KDPI was comparable in both groups (62.9 vs 60.9, p=0.54), however removal of HCV status from the KDPI equation unmasked higher KDPI in the D-/R- group (62.9 vs 37.3, p=0.01). In the D+/R- group 100% of patients develop HCV viremia on a median of POD 2.5 [0-17]. The median initial viral load was 876 copies/uL [range:10-1.0×10^8] with a median peak viral load of 4.8×10^5 copies/uL [range:495-1.0×10^8] on median of POD 7 [range:1-27]. Median days to viral clearance occurred on POD 58. All patients achieved SVR 12 weeks. Mean LOS (7.0±3.7 vs 5.1±2.4, p=0.01) and DGF (55 vs 27.5%, p=0.01) was higher in the D-/R- group. Rates of acute rejection, graft loss and death were comparable in both groups (Table 1). GFR was lower in the D-/R- group at 1-, 3- but comparable at 6-months (Table1). All patient tolerated DAA treatment with no adverse effects from treatment.

*Conclusions: D+/R- transplantation offers patients an alternative strategy to increase access to kidney transplantation. Development of HCV viremia was consistently observed but cleared following DAA treatment.

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