The safety of kidney transplantation from donors with positive blood or urine cultures is not well studied. Data regarding the outcomes and risks of infection in kidney recipients who receive organs from donors with positive cultures is scarce, particularly in the setting of post-transplant antimicrobial prophylaxis. We compared post-transplant outcomes in transplant recipients who received kidneys from donors with and without positive blood and/or urine cultures. We performed a retrospective, single-center study of renal transplant recipients aged >18 years who received organs from deceased donors with and without positive blood and/or urine cultures between 1/1/2016 and 12/31/2016. Pediatric-en-bloc kidney recipients were excluded. At our center, all recipients of an organ from a donor with positive blood or urine cultures are placed on 2-4 weeks of prophylactic antibiotics. Donor and recipient demographics, co-morbidities, and microbiologic data were collected. Post-transplant outcomes of interest included ICU stay, readmission, infection and graft and patient survival within 90 days after transplantation. Continuous variables were compared between groups using ANOVA while discrete variables were compared using Chi-squared analysis. 298 recipients received kidneys from 260 deceased donors. Donors with positive blood (n=32) or urine (n=52) cultures were more often women (54% vs. 34%, p=0.003), but otherwise did not differ from donors without positive blood or urine cultures. There were 211 recipients of a kidney without positive blood or urine cultures and 87 recipients of a kidney with positive blood or urine cultures. Recipient groups had similar distributions of age, gender, calculated panel reactive antibody percentage, estimated post-transplant survival score and dialysis modality. The positive cultures group had a higher proportion of glomerulonephritis as primary cause of kidney failure (p=0.02) and longer dialysis vintage (3.6 years vs. 2.8 years, p=0.05). Compared with recipients of kidneys from donors without positive cultures, recipients of kidneys from donors with positive cultures had higher rates of intensive care unit stay during their initial transplant hospitalization (8% vs. 1%, p=0.003) and readmissions (38% vs. 22%, p=0.004) within 90 days after transplantation (Table 1). The two groups did not differ in the proportion of recipients who developed infections (18% vs. 16%, p=0.63), including C. difficile (2.3% vs. 0.5%, p=0.15), within 90 days after transplantation. However, there was a higher rate of recurrent infections in recipients of kidneys with positive donor blood or urine cultures (p=0.008). One patient developed bacteremia with the same organism that grew in the donor culture. Ninety-day graft failure (3% vs. 6%, p=0.34) and recipient death (0% vs 1%, p=0.35) did not differ between groups. Table 1. Post-transplant outcomes by recipient groups. Transplantation of kidneys from donors with positive blood and/or urine cultures comes at the cost of increased recipient morbidity in terms of a more complicated post-transplant course, but it does not lead to worse 90-day graft or patient survival.