Division of Gastroenterology and Hepatology, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University, Chicago, Chicago, Illinois, USA.
Curr Opin Organ Transplant. 2018 Apr;23(2):237-243. doi: 10.1097/MOT.0000000000000505.
To highlight the current data for treatment of hepatitis C virus (HCV) in patients with hepatocellular carcinoma (HCC) awaiting orthotopic liver transplant and incorporation of various factors to decide the optimal time to initiate HCV therapy.
Viral eradication on the waiting list has been found to lead to significant clinical improvement in approximately 20% of HCV-positive patients. However, there have been concerns raised for direct-acting antiviral (DAA) therapy in patients listed with HCC. DAA therapy leading to rapid HCV clearance has been reported to be associated with an increased risk of HCC recurrence, especially when DAA therapy is initiated in close proximity to HCC therapy. Additionally, the presence of viable HCC may significantly lower the chances of achieving sustained virologic response. Lastly, sustained virologic response can decrease the organ pool in HCV-positive waitlisted patients.
The decision to treat HCV in patients listed for HCC pre vs. postliver transplant will require additional research.
强调目前在等待原位肝移植的肝细胞癌（HCC）患者中治疗丙型肝炎病毒（HCV）的现有数据，并纳入各种因素以决定开始 HCV 治疗的最佳时间。
在等待名单上消除病毒已被发现可使大约 20%的 HCV 阳性患者的临床状况显著改善。然而，对于 HCC 患者的直接作用抗病毒（DAA）治疗存在一些担忧。据报道，DAA 治疗导致 HCV 快速清除与 HCC 复发的风险增加相关，尤其是当 DAA 治疗在 HCC 治疗的附近开始时。此外，有活性的 HCC 的存在可能会显著降低实现持续病毒学应答的机会。最后，持续病毒学应答可减少 HCV 阳性等待名单患者中的器官库。
在 HCC 患者肝移植前 vs. 后治疗 HCV 的决定需要进一步研究。
