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Abstract Details
Optimal Timing of Administration of Direct-acting Antivirals for Patients With Hepatitis C-associated Hepatocellular Carcinoma Undergoing Liver Transplantation
Ann Surg. 2021 Oct 1;274(4):613-620. doi: 10.1097/SLA.0000000000005070.
Michael K Turgeon1, Shimul A Shah2, Aaron M Delman2, Benjamin V Tran3, Vatche G Agopian3, Joel P Wedd1, Joseph F Magliocca1, Ahyoung Kim4, Andrew Cameron4, Ali Olyaei5, Susan L Orloff5, Matthew P Anderson6, Chandrashekhar A Kubal6, Robert M Cannon7, Jayme E Locke7, Mary A Simpson8, Mohamed E Akoad8, Chelsey P Wongjirad9, Juliet Emamaullee9, Amika Moro10, Federico Aucejo10, Cyrus A Feizpour11, Parsia A Vagefi11, Mindie H Nguyen12, Carlos O Esquivel12, Kiran Dhanireddy13, Vijay Subramanian13, Alejandro Chavarriaga14, Marwan M Kazimi14, Maia S Anderson15, Christopher J Sonnenday15, Steven C Kim16, David P Foley16, Marwan Abdouljoud17, Reena J Salgia17, Dimitrios Moris18, Debra L Sudan18, Swaytha R Ganesh19, Abhinav Humar19, Majella Doyle20, William C Chapman20, Shishir K Maithel1
Author information
1Emory University, Atlanta, Georgia.
2University of Cincinnati College of Medicine, Cincinnati, Ohio.
3David Geffen School of Medicine at UCLA, Los Angeles, California.
4Johns Hopkins, Baltimore, Maryland.
5Oregon Health and Science University, Portland, Oregon.
6Indiana University Health, Indianapolis, Indiana.
7University of Alabama at Birmingham, Birmingham, Alabama.
8Lahey Hospital and Medical Center, Boston, Massachusetts.
9Keck Hospital of University of Southern California, Los Angeles, California.
10Cleveland Clinic, Cleveland, Ohio.
11UT Southwestern Medical Center, Dallas, Texas.
12Stanford University Medical Center, Palo Alto, California.
13Tampa General Hospital, Tampa, Florida.
14Piedmont Healthcare, Atlanta, Georgia.
15University of Michigan, Ann Arbor, Michigan.
16University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
17Henry Ford Health System, Detroit, Michigan.
18Duke University School of Medicine, North Carolina.
19University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
20Washington University School of Medicine at St. Louis, St. Louis, Missouri.
Abstract
Objective: To investigate the optimal timing of direct acting antiviral (DAA) administration in patients with hepatitis C-associated hepatocellular carcinoma (HCC) undergoing liver transplantation (LT).
Summary of background data: In patients with hepatitis C (HCV) associated HCC undergoing LT, the optimal timing of direct-acting antivirals (DAA) administration to achieve sustained virologic response (SVR) and improved oncologic outcomes remains a topic of much debate.
Methods: The United States HCC LT Consortium (2015-2019) was reviewed for patients with primary HCV-associated HCC who underwent LT and received DAA therapy at 20 institutions. Primary outcomes were SVR and HCC recurrence-free survival (RFS).
Results: Of 857 patients, 725 were within Milan criteria. SVR was associated with improved 5-year RFS (92% vs 77%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 92%, and 82%, and 5-year RFS of 93%, 94%, and 87%, respectively. Among 427 HCV treatment-naïve patients (no previous interferon therapy), patients who achieved SVR with DAAs had improved 5-year RFS (93% vs 76%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 93%, and 78% (P < 0.01) and 5-year RFS of 93%, 100%, and 83% (P = 0.01).
Conclusions: The optimal timing of DAA therapy appears to be 0 to 3 months after LT for HCV-associated HCC, given increased rates of SVR and improved RFS. Delayed administration after transplant should be avoided. A prospective randomized controlled trial is warranted to validate these results.