Are Hepatitis C Positive Female Liver Transplant Recipients Still at Increased Risk for Graft Failure? Re-Examining the Disparity in the Modern Era of Direct Acting Antiviral Agents.

BACKGROUND This study aimed to compare the outcomes of HCV+ female liver transplant recipients to HCV- female and HCV+ male recipients before and after the direct acting antivirals (DAA) era. METHODS The UNOS liver transplant database was retrospectively reviewed from 2002 - 2017. The DAA era was defined as > 2014. RESULTS In the pre-DAA era, HCV+ female recipients had greater risk for graft failure compared to HCV+ male (HR 1.06, 95% CI 1.01 - 1.11, p = 0.03) and HCV- female (HR 1.51, 95% CI 1.43 - 1.60, p < 0.001) recipients. In the post-DAA era, HCV+ female recipients had lower risk for graft failure compared to HCV+ male recipients (HR 0.82, 95% CI 0.70 - 0.97, p = 0.02) and equivalent outcomes to HCV- female recipients. HCV+ female recipients with graft failure had increased likelihood of graft failure due to disease recurrence compared to HCV+ male recipients in the pre-DAA era (OR 1.23, 95% CI 1.08 - 1.39, p = 0.001) but not in the post-DAA era. CONCLUSIONS While historically HCV+ female recipients were at disproportionately increased risk for graft failure and disease recurrence, this disparity has been eliminated in the DAA era.