*Purpose: To determine the effects of transplanting an HCV-positive solid organ to an uninfected patient who is on the transplant waiting list and might otherwise die awaiting a transplant. Outcomes include patient and graft survival, HCV infection and infection related complications.

*Methods: Retrospective cohort of all solid organ transplants at a single institution from HCV-positive donors (either HCV-antibody positive and/or HCV-NAT positive) to HCV-negative recipients between July 2017 and October 2019. All recipients received 12 weeks of post-transplant antiviral treatment if HCV-RNA became detectable

*Results: A total of 28 transplants (N=28) from HCV-positive donors to HCV-negative recipients were performed between July 2017 and October 2019. Mean Age of the recipients was 58.3 years. Sex of recipients consisted of males (N=18) and females (N=10). Transplanted organs comprised of heart (N=6), combined heart/kidney (N=2), kidney (N=14), liver (N=5), and combined liver/kidney (N=1). HCV donor serology consisted of 71.4% HCV-Ab positive/HCV-NAT positive (N=20), 17.8% HCV-Ab positive/HCV-NAT negative (N=5), and 10.7% HCV-Ab negative/HCV-NAT positive (N=3). 95% of the recipients receiving an HCV-Ab positive/HCV-NAT positive organ converted to HCV-NAT positive (N=19). The remaining 1 patient to receive an HCV-Ab positive/HCV-NAT positive organ died prior to becoming NAT positive. Conversion rates for recipients receiving either HCV-Ab positive/HCV-NAT negative or HCV-Ab negative/HCV-NAT positive was 0%. For the recipients in which HCV-RNA became detectable post-transplant (N=19), 12 weeks of antiviral treatment was initiated. Apart from 1 patient who is still in the treatment window, all HCV positive recipients were cured after antiviral treatment. 1 patient had a recurrence of HCV, which was cured after a second course of treatment. Total patient survival was 89.3%. A total of 3 patients (N=3) died, 1 in each of the HCV serology subgroups. All 3 patients were NAT negative at time of death. There were two graft losses (kidneys) from the same donor due to Primary Nonfunction. There were no major adverse events secondary to HCV treatment.

*Conclusions: Transplants from HCV-positive donors to HCV-negative recipients appears to be safe, and antiviral treatment was effective. Although all living recipients of HCV-Ab positive/HCV-NAT positive donors developed HCV viremia, the cure rate was 100% for those who completed the antiviral treatment.

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