*Purpose: The transplantation of Hepatitis C viremic (HCV) kidneys into uninfected recipients was made possible by effective direct acting anti-viral (DAA) therapy. This study aims to analyze the relationship between the donor HCV viral load and recipient HCV viral kinetics.

*Methods: A single center retrospective study of HCV naïve patients that received HCV nucleic acid test positive kidneys (D+/R-) was performed. Seven donors had documented donor HCV viral loads at time of transplantation. Recipient viral loads were measured at regular intervals following transplantation. Area under the curve (AUC) was calculated to represent the extent of viral burden in the recipients. Recipient peak viral load, viral load AUC, recipient age, date of DAA initiation, and type of induction were analyzed using a linear regression model. D+/R- patients were monitored post-operatively for development of viremia and were all subsequently treated with DAAs.

*Results: The average age in the D+/R- group was 43.4 years. The mean donor age was 36.5 years. KDPI was 57.1%. The mean donor viral load was found to be 3.05 x 10⁶ UI/L. The mean peak recipient viral load was 2.23 x 10⁶ IU/L. The mean AUC was 16.13 x 10⁶ (IU/L x days). The linear regression model showed no correlation between the donor viral load and the recipient peak viral load or the recipient viral load AUC (p = 0.7 and 0.6). DAA initiation and induction was also non-predictive.

*Conclusions: D+/R- transplantation offers patients an alternative strategy to increase access to kidney transplantation. Although, donor viral load did not correlate with the degree of recipient viremia, future studies may find this association significant with a larger cohort.

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