*Purpose: In 2014, direct-acting antivirals (DAAs) became available as a treatment option for Hepatitis C Virus (HCV) with successful results. Since the implementation of DAAs, the rate of HCV waitlisting for liver transplantation has decreased, but significant ethnic disparity exists. We hypothesized the rate of decline in HCV waitlisting for liver transplantation is significantly higher for African Americans (AA) compared with other ethnicities.

*Methods: We conducted a retrospective cohort study. OPTN national data reports of adult liver transplant candidates from 2014 to 2018 were utilized for the study. Pediatric patients (age <18 were excluded).

*Results: Overall, there was a decline in UNOS HCV waitlist rates for all ethnic groups (Caucasians, African Americans, and Hispanics). However, the waitlist rates were significantly higher in African Americans compared to Caucasians each year. In 2018, the waitlist rate among African Americans was 17.8% compared to 10.0% for Caucasians (OR 0.49; 95% CI 0.41-0.49; p<0.001) This trend was continuous across all years from 2014 through 2018. There were no differences in waitlist rates between Caucasians and Hispanics.

*Conclusions: The results show that healthcare disparities related to HCV waitlist disproportionately affect African Americans, and the trend remained unchanged from 2014 to 2018. The factors associated with this disparity need to be explored further to develop mechanisms to address these differences. By understanding the HCV treatment disparities across racial groups, modifications to HCV treatment nationwide can be adopted. Additional emphasis should be placed on African Americans to help reduce their waitlist prevalence rate, as well as redistributing resources to promote health equity.

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