*Purpose: Previous studies have demonstrated that female liver transplant recipients with hepatitis C (HCV) are at increased risk for graft failure due to disease recurrence compared to males. These studies, however, were conducted prior to the introduction of direct antiviral agents (DAA). The aim of this study is to determine if women with HCV are still at increased risk for graft failure and disease recurrence compared to men in the modern DAA era.

*Methods: The UNOS database was retrospectively reviewed for all primary liver transplants performed between 03/2002 and 12/2017. Recipients were categorized based on sex, HCV status defined by recipient serology, and era. Eras were defined as before and after 2014, the year when DAA became widely available and considered the mainstay treatment for chronic HCV.

*Results: 75,682 liver transplants were performed during the study period with 33% female recipients. Among recipients with HCV transplanted before 2014, women (n = 5,923) had a significantly higher risk for graft loss compared to men (n = 18,082) [HR = 1.09, 95%CI 1.04-1.14, p < 0.001], especially due to disease recurrence (OR 1.17, 95%CI 1.05-1.30, p = 0.004). After 2014, there was no longer a significant difference in risk for graft loss by recipient sex among patients with HCV (nwomen = 1,889, nmen = 5,820, p = 0.135). In the modern DAA era, women with and without HCV have equivalent graft survival (Figure 1).

*Conclusions: Female liver transplant recipients with HCV are no longer at increased risk for graft failure in the modern DAA era.

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