AbstractIntroductionUtilization of hepatitis C viremic (HCV+) deceased donor kidneys (DDKT) for aviremic recipients increases opportunities for transplantation with excellent short‐term outcomes. Our primary aim was to understand longer‐term outcomes, specifically assessing kidney and liver function in the first year posttransplant.MethodsThis was a retrospective single‐center study of adult DDKT recipients of HCV+ kidneys (cases) matched 1:1 to recipients of HCV‐ kidneys (comparators). Between‐group outcomes were analyzed using comparisons of means and proportions, survival analysis methods, and multivariable mixed effects models.ResultsSixty‐five cases and 65 comparators had statistically comparable demographic and clinical characteristics. There were no between‐group differences in serum creatinine or estimated glomerular filtration rate at month 12 (p = .662) or in their trajectories over months 1–12 (p > .292). Within the first 60 days, rates of liver function values >3 times upper limit of normal among cases were comparable to comparators for aspartate aminotransferase (AST) (14% vs. 6%, p = .242) and higher for alanine transaminase (ALT) (23% vs. 6%, p = .011). AST declined during the first 8 weeks (p = .005) and stabilized for both groups (p = .406) during the following 10 months. ALT declined during the first 8 weeks (p < .001), continued to decline over months 3–12 (p = .016), and the trajectory was unrelated to antiviral therapy initiation among cases.ConclusionsAviremic recipients of HCV+ kidneys had comparable kidney outcomes to matched recipients of HCV‐ kidneys. Despite more HCV+ recipients having an elevation in ALT within the first 60 days, ALT values normalized with no identified liver complications attributed to HCV. image