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Background Increased utilization of hepatitis C virus (HCV)-infected organs could reduce the supply–demand mismatch in organ transplantation. It is important to determine precise outcomes of HCV-positive organs transplanted into HCV-positive recipients (HCV D+\R+) to quantify risk for patients and other stakeholders. Small studies have identified shorter wait times in HCV D+\R+ compared with HCV-negative donor and HCV-positive recipients (HCV D−\R+), but there is little information about survival and rejection in the era of effective direct-acting antivirals (DAA). Methods We performed a retrospective cohort study of all cases of renal transplantation involving HCV-positive recipients at an academic medical center from 2008 to 2019. We extracted data using the institutional electronic transplant database. Demographics, incidence of organ rejection, renal function and patient mortality data were compared between HCV D+\R+ and HCV D−\R+. Results Among 3,781 patients who received a kidney transplant between 2008–19, 139 were HCV D-\R+ and 51 were HCV D+\R+. Both groups had similar waiting list time (1,196 ± 889 days vs. 1,301 ± 1240 days, P > 0.20), donor mean age (37 ± 11 y vs. 39 ± 13 years, P > 0.20) and sex (female: 37% vs. 42%, P > 0.20). Follow-up time was similar between both groups (5.2 ± 4 years vs. 5.3 ± 3 years, P > 0.20). The incidence of mortality (16% vs. 17%, P > 0.20) [Figure 1] and rejection (18% vs. 19%, P > 0.20) [Figure 2] was similar between two groups. Using a Cox Hazards model, we found no association between HCV D+/R+ and increasing risk of rejection (HR 0.92, 95% CI 0.43–1.95, P > 0.20) or mortality (HR 0.93, 95% CI 0.42–2.1, P > 0.20). In a multivariate analysis, age was the only independent risk factor for HCV D+/R+ mortality (HR = 1.09, 95% CI 1.03–1.14, P < 0.001). Conclusion Patients who are HCV-positive did not have worse mortality or graft rejection if they received HCV-positive kidneys compared with HCV-negative kidneys. Providers can use these data to give specific risk information to HCV-positive patients about accepting an HCV-positive kidney for transplant, even perhaps encouraging it. Increasing the utilization of HCV-positive kidneys for transplantation in the era of effective DAA has the potential to offer life-saving treatment to substantially more patients. Disclosures All authors: No reported disclosures.

1757. Hepatitis C-Infected Donors and Hepatitis C-Infected Recipients: Analysis of Renal Transplant Outcomes