*Purpose: Liver transplantation, LT, for HCV-related disease has the lowest five-year graft survival of all LT recipients, primarily due to accelerated fibrosis from unrestrained HCV replication. Optimal timing of HCV treatment with direct acting antiviral agents, DAAs, remains unknown. We compared those treated within the first year following LT to those treated before LT to determine if graft fibrosis differs with timing of treatment and LT.

*Methods: We studied HCV LT recipients with sustained viral response, SVR, after DAA treatment before LT or within 1 year of LT. Graft fibrosis was assessed using Fib-4 scores calculated at 1 year after LT if treated before LT and 1 year after SVR if treated after LT. Fib-4 scores &lt 1.45 defined minimal fibrosis.

*Results: We identified 117 LT recipients: 52 treated before LT and 65 treated within 1 year following LT, clinical characteristics in Table 1. Fib-4 scores were &lt 1.45 in 34% of participants overall, 39% of those treated after LT compared to 29% treated before had minimal fibrosis by Fib-4 score, p=0.28. The odds ratio of having minimal fibrosis was 1.54, 95% CI 0.71, 3.37, among those treated within 1 year after LT compared to those treated before LT, p-value 0.23.

*Conclusions: Treatment of HCV before or within one year of LT yields no difference in fibrosis. A third of LT patients had minimal graft fibrosis one year post-SVR, supporting recommendations for early treatment to prevent HCV-related fibrosis.

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