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Abstract Details
Direct-Acting Antiviral Therapy in Liver Transplant Patients With Hepatocellular Carcinoma and Hepatitis C
Transplant Direct. 2020 Dec 8;7(1):e635. doi: 10.1097/TXD.0000000000001049.eCollection 2021 Jan.
Chung Sang Tse12, Ju Dong Yang345, Omar Y Mousa67, Kevin M Nelson6, Surakit Pungpapong7, Andrew Keaveny7, Bashar A Aqel8, Hugo Vargas8, Rolland C Dickson8, Kymberly Watt6, Gregory J Gores6, Lewis R Roberts6, Michael D Leise6
Author information
1Division of Gastroenterology, Brown University, Providence, RI.
2Department of Internal Medicine, Mayo Clinic, Rochester, MN.
3Division of Digestive and Liver Diseases, Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA.
4Comprehensive Transplant Center, Cedars Sinai Medical Center, Los Angeles, CA.
5Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA.
6Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
7Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL.
8Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ.
Abstract
Direct-acting antivirals (DAA) are highly effective for the treatment of hepatitis C (HCV), although there are limited data on the safety and efficacy of DAA therapy in hepatitis C-positive individuals awaiting liver transplantation for hepatocellular carcinoma (HCC).
Methods: We conducted a retrospective cohort study of HCV-positive patients who underwent liver transplantation for HCC at 3 liver transplant centers across the United States from 2014 to 2017 with follow-up to July 2018. Transplant recipients who received DAA before transplant were compared with those who did not (DAA naive) for posttransplant HCC recurrence rate, sustained virological response (SVR), allograft failure, and death using Kaplan-Meier analysis and Cox proportional hazard models.
Results: A total of 171 HCV-HCC transplant recipients (99 pretransplant DAA; 72 DAA naive controls) were included, with a median follow-up of 24 months. The overall posttransplant HCC recurrence rate was 9% (15/171). Pretransplant DAA was not associated with HCC recurrence (5% versus 14%; P = 0.07), graft failure (7% versus 3%; P = 0.21), or death (12% versus 19%; P = 0.19) as compared with DAA naive patients. SVR rates were significantly lower (P < 0.01) with pretransplant DAA (75%, 39/52) than posttransplant DAA (97%, 59/61) therapies. Those who received pretransplant DAA and those who did not were not statistically different in age, gender, alpha fetal protein levels, model for end-stage liver disease scores, or transplant wait time.
Conclusions: Pretransplant DAA for HCV was not associated with an increased risk of posttransplant HCC recurrence, though pretransplant DAA had lower efficacy than posttransplant DAA in HCV-HCC transplant recipients.