*Purpose: With direct-acting antiviral (DAA) therapy, we feel that HCV+ organs are safe for all patients regardless of their HCV status and have adopted a programmatic change to offer HCV+ livers to all waitlisted patients eligible to receive DAA therapy post-transplant. Here, we analyze how this has impacted our patient access to transplant.

*Methods: We reviewed all liver transplants performed at our center beginning one year prior to implementation of our HCV+ donor protocol (June 1, 2017 – June 14, 2018; n=180) and compared them to transplants performed after protocol implementation (June 15, 2018 – Nov 9, 2018; n=94).

*Results: Liver transplants from HCV+ donors to HCV- recipients (n=30) has represented 32% of the total transplant volume. Although our early data has yet to reach statistical significance, we identified several important trends. We noted a reduction in waitlist days after protocol implementation (55 vs 37, p=0.229). Importantly, this trend was observed in both HCV viremic (55 vs 19, p=0.1342) and non-viremic recipients (56 vs 43, p=0.4420). Notably, we saw the greatest reduction in waitlist days in our highest surgical complexity patients, which have been historically difficult to transplant (160 vs 70, p=0.3826). Early post-implementation clinical outcomes have been excellent as we have not encountered any barriers to approval for DAA therapy and have observed 100% patient and graft survival.

*Conclusions: In the era of DAA therapy, HCV+ donor livers can be used safely, with good outcomes. Early trends support the notion that broadening access to HCV+ livers increases access to liver transplant. Importantly, this leads to reduction in waitlist days without any unintended consequences on subsets of our waitlist population.

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