*Purpose: In September 2018, we began offering carefully screened kidney transplant candidates the opportunity for transplantation with kidneys from hepatitis C (HCV) positive deceased donors. The average annual cost of dialysis in the US is estimated to be $90,700 and the wait time for deceased donor kidney transplant varies between 4.93 to 6.90 years depending on location, blood group and PRA. This translates to a per patient cost of between $447,151 and $625,830. We now report on the effect this practice change had on waiting time and dialysis costs.

*Methods: Between 9/1/18 and 10/15/19, 71 kidney transplants were performed. Recipients of live donor or simultaneous liver-kidney grafts were not analyzed (n=23); the study cohort consisted of 48 recipients of DD kidneys. Demographics, disease etiology, time on dialysis, total costs of dialysis and effect of blood group on wit time were compared. Categorical variables were analyzed using Chi-Square or Fischer’s exact test; continuous variables were analyzed using Student’s T test (SPSS version 24). Significance was set at p<0.05.

*Results: 28 patients received HCV neg kidneys (group1) and 20 received HCV pos kidneys (Group 2). Demographics and mean cold ischemic times were similar (Table 1). Patients in Group 2 had significantly shorter wait times (2.78 vs. 4.26 years, p=0.05) and dialysis costs ($252,695 vs. $387,855, p=0.046) than patients in Group 1. The difference persisted when cost of HCV treatment was added (Group 2 = $277,695 vs. Group 1 = $387,855, p=0.048). The differences were most pronounced in blood group O recipients. Wait time for type O Group 1 = 5.98 years vs. Group 2=3.6 years, p= 0.003 while dialysis costs were $544,090 vs. $236,107, p=0.003. The mean time from listing for HCV + donor to transplant was 60.8 days (range 11-295).

*Conclusions: 1. Acceptance of HCV positive kidneys shortens time on wait list; 2. Shorter wait times leads to lower dialysis associated costs; 3. Cost savings persist even when DAA costs are factored in; 4. Blood Group O recipients derive greatest benefit.

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