Background: Improvements in the tolerability and efficacy of hepatitis C virus (HCV) direct-acting antiviral agents have dramatically increased HCV cure rates. As such, kidney transplantation from HCV-infected donors into HCV-negative recipients is now possible, and represents a potent way to increase the organ donor pool and decrease recipient waitlist times without sacrificing patient safety or graft function. Methods: An IRB-approved, retrospective chart review was performed of all renal transplant recipients from HCV-NAT+ donors at Duke University Hospital, from Dec 2018 through May 2019. Donor and recipient characteristics, waitlist duration, treatment regimens, time from transplantation to HCV treatment, and clinical outcomes were identified. Results: Twenty-three transplants (22 kidney, 1 heart-kidney) were performed from 19 HCV NAT+ donors. 22 recipients became viremic, all by post-transplant day 5, at a median viral load 12,897 copies/mL. One likely HCV false-positive donor was identified. A mixture of genotypes was observed, including genotype-3 in 5 of 21 recipients, a higher rate than usually observed nationally in the USA. Median recipient age was 57 years; 61% were male, 52% were of black race. Conversely, median donor age was 37 years and median KDPI% = 62. 17/19 donors used intravenous drugs, and 9 died directly from overdose. Time from general listing to transplant was 406 days, yet from HCV-NAT+ consent to transplant was just 15 days. HCV treatment was initiated as an outpatient in each case, approved through the patient’s insurance, with a delay of 36 days post-transplant (IQR 30-51). All patients were treated with either glecaprevir/pibrentasvir or sofosbuvir/ledipasvir, and managed by a team including nephrologists, transplant surgeons, infectious disease specialists and transplant pharmacists. Delayed graft function was noted in 3 recipients, and only 1 episode of rejection was seen – these were not felt to be due to HCV infection. No significant transaminitis was observed. Conclusions: Recipient wait times to transplantation are significantly decreased when using organs from HCV-infected donors. In a real-world setting, recipients from such donors became infected rapidly, within the first week after transplant, yet patients were safely treated in a timely manner, without evidence of injury to the patient or graft. These data can serve as a model for other kidney transplant programs.