*Purpose: Kidney donor profile index (KDPI) is composed of 10 variables that are used to estimate the quality of a kidney. Hepatitis C virus (HCV) positivity, one of the components, confers a hazard ratio of 1.27 for inferior graft quality. This risk stratification was proposed in 2009, prior to the introduction of the direct antiviral agents (DAA) that have drastically improved HCV treatment and transplant survival. Kidney discard rates are thought to be closely related to their KDPI. The aim of this study was to examine and compare patient and graft outcomes between donor HCV positive (D+) kidneys transplanted into HCV negative recipients (R-) to HCV negative donor (D-) kidneys transplanted into R-. In addition, we evaluated the impact HCV has on KDPI.

*Methods: Scientific Registry of Transplant Recipients (SRTR) data files were obtained for transplants between July 1, 2016 to June 30, 2020. Simultaneous transplant or listing, en-bloc, living donor, and recipients less than 18 years old were excluded from the study. A total of 50,283 kidney transplants were included in the study.

*Results: There were 3,050 HCV D+/R- transplants and 47,233 D-/R- included during the study period. D+/R- donors were younger with lower BMI. Terminal Cr were similar between the two groups. D-/R- donors were more likely to be hypertensive, diabetic, DCD and African American. Despite all those factors contributing to KDPI, the KDPI for the D+/R- was higher (54% vs 40%) (p<0.0001)). The adjusted KDPI (treating D+ as D-) was 29% for the group. D+/R- showed significantly greater graft survival rates at both one-year graft survival (95.5% vs 94.5%) (p=0.0005) and two-year graft survival (93.1% vs 91.4%) (p=0.0036). At 3 and 4 years post-Transplant there was no significant difference between the two groups in terms of graft survival but D+/R- group had slightly better survival. Mapping the graft survival of HCV positive group showed closer concordance to the adjusted KDPI score than the original KDPI score.

*Conclusions: Despite having a higher KDPI, D+/R- had a higher graft survival. This highlights that the negligible role of HCV in the era of DAA affecting graft survival. Removal of HCV from KDPI may lead to increase utilization and acceptance of these organs and reflect a more accurate assessment of kidney quality.

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