*Purpose: Overall mortality on the kidney transplant waiting list is higher for older patients. The average age of waitlisted veteran patients is 64, with patients listed up through the age of 75. Expansion of the donor pool would result in increased transplantation rates and decrease mortality on the waitlist. Recent data has shown the safety and benefits of using kidneys from HCV viremic [HCV NAT (+)] donors. However, HCV NAT (+) status increases the KDPI calculation in Donor Net. High KDPI donor (>85%) utilization has not changed much in the last 5 years with less than half of all waitlisted patients willing to accept these donors. Approximately 18%-20% of deceased donor kidneys are discarded evert year with discard rates close to 50% for kidneys with KDPI >85%. Additionally, close to 40% of all HCV Viremic donors’ kidneys are discarded yearly. This study aims to determine whether eliminating HCV status from KDPI calculations may improve transplant rates and outcomes.

*Methods: KDPI was recalculated amongst patients receiving HCV NAT (+) kidneys by answering “NO” on HCV status. Our cohorts were 15 deceased donor kidney transplant (DDKT) recipients with HCV NAT (+) kidneys and 19 DDKT recipients with negative HCV NAT testing donors transplanted between 11/2020 and 11/2021. HCV NAT (+) recipients were treated with once daily Mayvret(glecaprevir 300mg/pibrentasvir 120mg) started at least 30 minutes pre-operatively and continued for 8 weeks. Other endpoints included liver function, adverse effects, and patient and graft survival.

*Results: HCV NAT (+) donors were younger (61.3 vs 64.7 yrs., p=0.011). Donor Age, original KDPI, and cold ischemia time (CIT) were equivalent amongst both cohorts [HCV NAT (+), 38.85 yrs. vs 41.3 yrs., 59.5% vs 57.56%, and 21.6 hrs. vs. 18.1 hrs.; p>0.05]. Adjusted KDPI for HCV NAT (+) donors dropped from 57.56% to 40.4% (p<0.027). 4/15 patients KDPI changed from 94-97% to <87%. Median serum creatinine was better in the HCV NAT (+) cohort [1.23 (0.6-2.03) mg/dL vs 1.82 (1-2.62) mg/dL, p-value 0.014]. Qualifying listing days and dialysis vintage was not-significantly different amongst both cohorts. SVR12 is 100% in 11/15 patients, with the remaining four patients currently negative. There was no BPAR and 100% patient and graft survival. One patient developed BK viremia.

*Conclusions: HCV NAT (+) status increases KDPI calculations by almost 20% points and are not truly reflective of actual donor risk. HCV NAT (+) donors were younger with a lower recalculated KDPI, which correlated to improved graft function and minimal complications in an elderly veteran population. Therefore, eliminating HCV status from KDPI calculations may result in increased utilization with excellent outcomes.

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