*Purpose: Despite robust evidence supporting the safety and efficacy of HCV-infected donor kidneys, great heterogeneity continues to exist regarding centers willingness to utilize these in HCV negative recipients. In 2019, our transplant center began utilizing these kidneys as standard of care. Processes were approved by institutional and transplant quality teams. All patients received education regarding HCV-infected donors and were approached for consent during evaluation. Eligible candidates were discussed in multidisciplinary selection committee. Financial and case management verification of HCV treatment coverage is required prior to listing. Post-transplant, nephrology/pharmacy-driven monitoring/treatment were completed per center protocols. We report here the experience of our multidisciplinary comprehensive approach to utilizing HCV-infected donor kidneys.

*Methods: Recipients of HCV-nucleic acid test (NAT) and/or antibody (ab) positive donors were prospectively monitored for protocol adherence. Retrospective chart review was completed for transplants between July 2019 and October 2020. Donor/recipient characteristics, clinical outcomes, and HCV treatment details were collected.

*Results: During the time period, 152 kidneys were transplanted at our center, 30 (20%) were from HCV-infected donors. Donor/recipient characteristics are summarized in Table 1. Adherence to testing schedule per protocol was 100%. No HCV transmission occurred in recipients of HCVAb+/NAT- donor kidneys. HCV viremia was detected in all 20 recipients of HCVNAT+ donors. Treatments were initiated in all infected recipients within 1 month following transplant. All insurances required HCV genotype and prior authorization for medication approval. No therapy failure or resistance were reported. At last follow-up, 19 of the 20 patients completed HCV treatment, 16 patients achieved SVR-12, and 1 patient is yet to start therapy. Overall, 10 (33%) patients had transient transaminitis which resolved at last follow-up.

*Conclusions: Safe and effective utilization of HCV-infected donor kidneys outside the context of clinical trials is feasible and requires center-specific protocols involving multiple disciplines. Partnership with a designated specialty pharmacy and protocolized pathways lead to prompt treatment initiation to reduce potential risk of HCV-related complications. HCV-infected donors continue to provide a significant source of kidneys to increase transplant volume and shorten wait time.

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