Hepatitis C is one of the most common etiologies for chronic liver disease, cirrhosis, and hepatocellular carcinoma. The majority of liver transplants performed today are due to end stage liver disease induced by chronic hepatitis C. The prevalence of the disease is not the same across various races and a great epidemiologic disparity exists. Hepatitis C virus is more prevalent in the African American population with a higher rate of detectable viremia, predominance of genotype 1, and a higher viral load. Paradoxically the natural history of the disease and the progression to cirrhosis is less accelerated, although the development of hepatocellular carcinoma is more evident. African Americans in particular are resistant to antiviral regimens and the response to treatment with interferon monotherapy, a combination of interferon and ribavirin or pegylated interferon and ribavirin is significantly less. There are on going studies that determine the mechanisms in the lack of response in African Americans. An underrepresentation of African Americans in various study trials that are consequently on a list for a liver transplant have been noted and is postulated that the survival after liver transplantation is not equivalent to the one reported for other races, for unclear reasons.