*Purpose: The use of hepatitis C (hep C) positive donors has become increasingly attractive with the advent of improved curative pharmacologic treatments. As a result of these breakthroughs, there has been a growing utilization of hep C positive donors for kidney transplant (KT). As an early adopter, our institution aimed to identify whether hep C positive organs could safely be used in our patient population and whether there was a significant financial impact.

*Methods: We queried our center’s internal transplant database for all kidney transplants (n=214) performed in 2018. Cohorts were stratified according to donor nucleic acid amplification testing (NAT) into hep C+ and hep C- cohorts. The potential cost savings of reduced dialysis treatments against hep C treatment expenses for medications was compared, as well as the peri- and post-operative outcomes at one and three months using univariate tests of association and multivariable logistic regression. The U.S. Renal Data System was used to estimate the average cost per treatment of hemodialysis ($461) and peritoneal dialysis ($145).

*Results: Our query resulted in a total of 214 adult kidney transplants, 36% (n=76) were from hep C NAT + donors (hep C+). The hep C+ cohort had a significant average cost reduction of $97,000 compared to the hep C- cohort ($201,666 v. $298,728, p<0.001). Kidney transplant total wait time was also significantly less for the hep C+ cohort compared to the hep C- cohort (22mo v. 54mo, p<0.0001). There was no significant difference in the postoperative hospital LOS between cohorts. Some demographic differences were identified; the hep C+ cohort was older (70yo v. 60yo, p<0.001) and comprised of more males (76% v. 24%, p=0.035). .At one month and three months follow up, quantitative laboratory results were similar with no clinically significant differences. Serum creatinine (1.02 v. 1.34, p=0.025) was statistically significantly lower in the hep C+ cohort compared to the hep C- cohort at 3 months post KT.

*Conclusions: We found that well selected hepatitis C NAT positive kidney donors can be safely transplanted into our patients with a significant reduction in waiting time of more than 2 years, as well as have comparable, if not better outcomes in the immediate perioperative period through the early post-transplant period. Additional long term follow up is needed to determine whether any long-term graft survival differences exist between these two cohorts. The expansion of the current donor pool through the use of hep C+ kidneys for transplantation has tremendous cost savings and quality of life implications that need further understanding.

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