LAUSR

FIGURE 1. Annual rate for AGF in HCV compared to non-HCV LT recipients in the United States from 2011 to 2016. L iver transplantation of patients with untreated hepatitis C virus (HCV) infection leads to universal reinfection of the graft. Up to 10% of liver transplant (LT) recipients with recurrent HCV infection can develop fibrosing cholestatic hepatitis (FCH) followed by acute graft failure (AGF). LT recipients with severe and rapid recurrence of HCV infection, including FCH and cirrhosis-related hepatic decompensation with a life expectancy of 1 year or less were offered treatment under the sofosbuvir compassionate use program in 2013 (prior to regulatory approval of sofosbuvir). Due to the lack of direct corroborating evidence, it has been presumed that direct-acting antiviral (DAA) agents, such as sofosbuvir, may have impacted and potentially improved the short-term graft survival in HCV LT recipients. Using the United Network for Organ Sharing (UNOS) registry, annual rates for AGF were analyzed among HCVand non-HCV LT recipients. AGF was defined as graft failure diagnosed within 1-year of LT surgery and documented in the UNOS registry. From 2011 to 2016, there was a significant decline in the annual rate of AGF in HCV compared with non-HCV LT recipients (Figure 1). Notably, AGF rate in HCV group declined sharply in 2013 to 2014 by 26.3%. From 2014 to 2016 (DAA era), annual rates for AGF in HCV and non-HCV LT recipients were comparable and statistically insignificant (HCV 3.6% vs non-HCV 3.5; P = 0.85). For the first time in 2016, AGF rate in HCV LT recipients was observed to be lower