*Purpose: Kidneys from donors infected with hepatitis C virus (HCV) are increasingly used for transplantation into HCV positive (+) recipients historically and into HCV negative (-) recipients in recent years with the intention to treat these recipients with highly effective directly acting anti-HCV agents in the post transplant period. The purpose of our study was to compare the outcomes of transplanting HCV + kidneys into HCV + vs. HCV- recipients using a mate kidney model in which one kidney from HCV + donor was transplanted into HCV + recipient and the mate kidney into HCV – recipient.

*Methods: Utilizing the OPTN/UNOS database from January 2015 to December 2019, we identified HCV nucleic acid test (NAT) positive deceased donors where one kidney was transplanted into HCV + (antibody+or antibody + and NAT+) recipient and the mate kidney was transplanted into HCV antibody – recipient. The incidence of delayed graft function (DGF, defined as the need for dialysis within the first week of transplant), along with graft survival, death-censored graft survival and patient survival (using Kaplan-Meier method) were compared between the groups.

*Results: Median study follow-up was 7 months. We identified 134 eligible HCV NAT+ deceased donors from whom one kidney was transplanted into HCV+ and the mate kidney into HCV- recipients. Proportion of mate kidney transplants increased over the years as follows: 5.2% in 2015, 7.5% in 2016, 10.5% in 2017, 33.6% in 2018 and 43.3% in 2019. DGF developed in 33 HCV+ and 30 HCV- recipients (p=0.7). During the follow up, there were 11 graft losses and 7 patient deaths in HCV+ group while there were 4 graft losses and 2 patient deaths in HCV- group. Kaplan-Meier analysis showed superior patient survival (log-rank p=0.03) in HCV- recipients (figure 1). Graft survival trended superior (log-rank p=0.06) and death-censored graft survival remained similar for HCV- vs.HCV+ recipients.

*Conclusions: Our study showed increasing utilization of HCV NAT + donor kidneys for transplantation into HCV naive recipients in recent years. This reflects the availability of highly effective direct acting anti-viral agents to treat HCV infection. Improved patient survival and similar death-censored graft survival following the transplantation of HCV NAT+ kidney into HCV – vs. HCV + recipients indicate fewer death with functioning grafts in HCV- group. Superior patient survival in HCV- group is reflective of the overall better health status of HCV- compared to HCV+ kidney recipients.

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