*Purpose: The evolution of effective direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV), in the setting of the well recognized organ shortage and the opioid epidemic, initiated a new era in the usage of HCV-infected donor organs for HCV naïve patients. We present a case-series of twenty patients that received a liver transplant from donors known to be infected with HCV based on positive pre-transplant nucleic acid testing (HCV NAT+) and/or HCV antibody (HCV Ab+) testing.

*Methods: Clinical data for adult liver transplant recipients with donor-derived HCV infection from January 2018 to August 2019 at our institution was collected from the medical record.

*Results: Sixteen recipients were HCV naive and four patients had a prior diagnosis of HCV and at the time of transplantation were HCV Ab+ but non-viremic (table 2). Three patients received a simultaneous liver-kidney transplant from viremic donors. Out of twenty (20) recipients, fifteen (15) developed HCV infection from a NAT positive donor and achieved sustained virologic response post-treatment with DAA-based regimens. The median time from treatment initiation to non-viremia was 26 days. There was one patient (patient 1) who received a transplant from a HCV Ab+/NAT+ donor and never became viremic and as such never received treatment. The median MELD score for the twenty recipients reviewed was 25 which appears lower than the average MELD score for liver transplant recipients in our region (32).

*Conclusions: Transplantation of HCV-viremic livers into non-viremic recipients seems to be an acceptable practice with similar short-term outcomes to non-viremic livers. Offering this option to patients awaiting liver transplant may expand the donor pool and increase access to liver transplantation$

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