*Purpose: This study describes outcomes, out to 3 years, at one of the first centers in the United States to begin Hepatitis C Virus (HCV)-Nucleic Acid Amplification Testing (NAT) positive donor to HCV-NAT negative recipient liver transplantation (LT).

*Methods: Since September 2016, a total of 22 HCV HCV-NAT positive donor to an HCV-NAT negative recipient liver transplants have been performed at Intermountain Medical Center under an organ acceptance protocol, a treatment assurance pathway for direct acting antiviral (DAA) medication access, and multiple layers of patient education.

*Results: The cohort of 22 patients has an overall graft survival rate of 95.4%. Fifteen patients have been followed for at least one year with a graft survival of 93.3%. One death was observed due to a ruptured hepatic artery pseudoaneurysm in a patient transplanted for cholangiocarcinoma complicating PSC. The most common diagnoses for liver disease were non-alcoholic steatohepatitis (7/22), primary sclerosing cholangitis (6/22), and alcoholic cirrhosis (4/22). Four patients had concurrent liver malignancy, three of which were hepatocellular carcinoma and one cholangiocarcinoma. The median physiologic MELD at transplant was 23, and median allocation was MELD 24 at the time of LT for this group. Median waiting time was 303.5 days. Outside of this cohort our institution’s median allocation MELD was 28 during this same period. DAA therapy began at a median time of 58 days after LT. To date 21 patients have started and 20 have completed a 12-week courses of DAA therapy with 17 achieving sustained viral response. No HCV viremia relapses have occurred. Since September 2016 our program has observed a decreasing trend in the median institutional MELD at time of LT and a trend towards decrease in waitlist time.

*Conclusions: This series of HCV-NAT positive donors to HCV-NAT negative treatment naïve patients has shown favorable short- and intermediate-term graft- and patient-survival consistent with national overall LT data. These results will contribute to the growing evidence supporting the role of HCV-NAT positive donors in well selected HCV-NAT negative recipients.

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