*Purpose: There is limited data on the use of direct acting antivirals for hepatitis C virus (HCV) in the solid organ transplant (SOT) population. The purpose of this study is to assess the incidence of sustained virologic response at 12 weeks after completion of hepatitis C treatment (SVR12) in SOT recipients. The results from this study may add to the limited literature available regarding the outcomes of direct acting antivirals in SOT recipients.

*Methods: A single center retrospective, observational chart review was performed in SOT recipients diagnosed with recurrent HCV post-transplantation, who were treated with direct acting antiviral medications between January 2013 and January 2018. The primary endpoint was the achievement of SVR12. Patients were excluded if they had active human immunodeficiency virus infection, had active hepatitis B infection, or did not complete HCV therapy.

*Results: A total of 90 patients were included in this study: 73 liver recipients, 8 kidney recipients, and 9 liver/kidney recipients. Of these, 70% were male, 48% were Caucasian, 47% were treatment experienced, 8% had decompensated cirrhosis, and 79% had genotype 1 infection. The primary endpoint was reached in 96.7% (87/90) of patients. 59% of patients were on steroid-free immunosuppression, 30% were receiving a mean dose of <10 mg/day of prednisone during HCV therapy, and 11% were receiving a mean dose of ≥10 mg/day of prednisone during HCV therapy. Three patients experienced virologic relapse: two patients in the steroid-free group and one patient in the<10 mg/day prednisone group. Five patients experienced biopsy proven rejection within one year of HCV treatment, with four of these patients receiving high dose steroids as treatment. None of these patients experienced virologic relapse after rejection treatment.

*Conclusions: In this retrospective chart review, we found that 96.7% of patients achieved SVR12, which is comparable to previous studies that have looked at SVR12 in the post-transplant population. Virologic relapse was not seen in patients who experienced rejection and were treated with high dose steroids. In addition, there seemed to be no difference in the rate of virologic relapse for patients who were on steroid-free immunosuppression (4%) versus those who were receiving <10 mg/day prednisone (3%) during the course of HCV therapy.

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