*Purpose: We report our experience on virologic and graft outcomes of HCV-negative patients transplanted with HCV NAT+ (viremic) and HCV Ab+/NAT- (non-viremic) livers and kidneys from 2017 to 2020.

*Methods: All recipients were HCV RNA- pretransplant. HCV Ab and RNA testing was done 1-, 3-, and 12-months post-transplant. Non-viremic organs were routinely offered to patients after informed consent. Patients transplanted viremic organs were enrolled in IRB-approved studies, and after confirmation of HCV RNA positivity were treated for 12 weeks (kidney patients with Epclusa, liver patients with Mavyret or Harvoni).

*Results: Kidney and liver recipients received thymoglobulin and Basilixumab, respectively. Immunosuppression consisted of tacrolimus and steroids ± MMF. HCV Ab+/NAT- (non-viremic) donor organs: 91 kidney and 19 liver patients have been transplanted (Table). 40 (44%) kidney and 7 (37%) liver recipients seroconverted, becoming HCV Ab+ post-transplant. However, no HCV transmission occurred in kidney transplant patients (100% HCV RNA negative with follow-up post-transplant of 25.1±13.5 months) and only 1 (5%) liver patient became HCV RNA positive but achieved SVR with treatment (follow-up post liver transplant, 21.4±10.3 months). HCV NAT+ (viremic) donors: 8 kidney and 7 liver patients have been transplanted; all were HCV RNA- prior to transplant. 13 patients were Genotype 1a and 2 were Genotype 3 (1 liver, 1 kidney). No patients were denied HCV treatment; insurance authorization was 100%. Mean follow-up post kidney transplant was 5±1.7 months. Patients started treatment 3.9 ± 0.9 weeks post-transplant. Seven of 8 kidney transplant patients are HCV RNA negative; 6 achieved SVR and the other patient was HCV RNA negative but died while on 10 weeks of treatment. The 8^th patient recently started treatment. Mean follow-up post liver transplant was 14.1±7.1 months. Patients initiated treatment at 11.6±7.4 weeks post-transplant. All 7 (100%) liver recipients have achieved SVR. Side effects were minimal to none. Graft outcomes. One-and 3-year kidney graft survival is 95% and 88%, respectively. One- and 3-year liver graft survival is both 95%.

*Conclusions: Transplantation of HCV Ab+/NAT- liver and kidneys to HCV-negative recipients is safe; incidence of HCV transmission was 1/110 (0.9%). 100% of HCV-negative patients transplanted with HCV NAT+ organs achieved SVR. We propose that transplantation of HCV viremic and non-viremic liver and kidneys into HCV-negative patients become standard of care.

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