The Impact of Direct-acting Antivirals on Overall Mortality and Tumoral Recurrence in Patients With Hepatocellular Carcinoma Listed for Liver Transplantation: An International Multicenter Study.

Gorgen, Andre, Galvin, Zita, Huang, Annsa C, Vinaixa, Carmen, O'Rourke, Joanne M, Francoz, Claire, Hansen, Bettina E, Durand, François, Elsharkawy, Ahmed M, Shah, Tahir, Berenguer, Marina, Rubin, Angel, Calatayud, David, Mehta, Neil, Terrault, Norah A, Lilly, Les B, Selzner, Nazia and Sapisochin, Gonzalo (2020) The Impact of Direct-acting Antivirals on Overall Mortality and Tumoral Recurrence in Patients With Hepatocellular Carcinoma Listed for Liver Transplantation: An International Multicenter Study. Transplantation, 104 (10). pp. 2087-2096. ISSN 1534-6080.

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Official URL: https://journals.lww.com/transplantjournal/Abstrac...

Abstract

BACKGROUND

There is a lack of data on the use of direct-acting antivirals (DAA) on the risk of death and tumoral recurrence in patients with hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) listed for liver transplantation (LT). We aimed to assess the impact of antiviral treatment on mortality and HCC recurrence patients with HCC-HCV.

METHODS

This was a retrospective multicenter study of patients with HCC-HCV listed for LT from 2005 to 2015. Patients were divided according to the antiviral treatment received after HCC diagnosis: DAA, interferon (IFN), or no antiviral. Intention-to-treat overall survival and HCC recurrence incidence were compared by the Kaplan-Meier method. Multivariable regression analysis was performed to identify risk factors for outcomes.

RESULTS

A total of 1012 HCV-HCC patients were listed for LT during the study period. The median follow-up was 4.0 (interquartile range = 2.3-6.7) years. Mortality was 5.6 (95% confidence interval [CI], 4.3-7.2), 13.1 (95% CI, 11.0-15.7), and 6.2 (95% CI, 5.4-7.2) deaths per 100 person-year among patients treated with DAA, IFN, and antiviral naïve, respectively (P < 0.001). Of the 875 HCV-HCC transplant recipients, the 5-year recurrence-free survival was 93.4%, 84.8%, 73.9% for the pre-LT DAA, pre-LT IFN, and antiviral naïve groups, respectively (P < 0.001). After multivariable regression, the use of pre-LT DAA was not associated to risk of recurrence (hazard ratio = 0.44 [95% CI, 0.19-1.00]). Post-LT DAA was not related to increased risk of recurrence (hazard ratio = 0.62 [95% CI, 0.33-1.16]).

CONCLUSIONS

In this multicenter intent-to-treat study, DAA therapy was not found to be a risk factor for mortality or HCC recurrence after adjusting for potential confounders.

Item Type: Article
Subjects: QZ Pathology. Oncology
WI Digestive system. Gastroenterology
WO Surgery
Divisions: Planned IP Care > Gastroentrology
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Depositing User: Beth Connors
Date Deposited: 24 Feb 2021 12:57
Last Modified: 24 Feb 2021 12:57
URI: http://www.repository.uhblibrary.co.uk/id/eprint/4001

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