Division of Transplantation, Department of Surgery, College of Medicine, Pennsylvania State University, Mail Code H062, 500 University Drive, PO Box 850, Hershey, PA, 17033-0850, USA.
Division of Gastroenterology, Department of Medicine, College of Medicine, Pennsylvania State University, Hershey, PA, USA.
Hepatol Int. 2019 Mar;13(2):190-198. doi: 10.1007/s12072-019-09930-x. Epub 2019 Jan 24.
Recently, a controversy has emerged: is the rate of recurrence of hepatocellular carcinoma (HCC) higher following treatment of hepatitis C virus (HCV) with direct-acting antiviral (DAA) therapy? However, the risk of HCC recurrence has not been studied in liver transplant (LTx) recipients who received DAA therapy. The aim of the present study is to compare the rate of HCC recurrence in LTx recipients who did or did not receive DAA therapy.
Sixty-three patients received LTx with HCC. Twenty-seven (42.9%) with HCV received DAA therapy (Group A), 20 (31.7%) with HCV did not receive DAA therapy (Group B), and 16 (25.4%) did not have HCV (Group C).
In group A, three (11%), in group B, one (5%), and in group C, none had recurrence of HCC. Actuarial 4-year recurrence-free survival was 88.9, 95, and 100% in group A, B, and C, respectively (p = 0.37). Group A was subdivided into two groups for comparison with Group B: A1 included five patients who had end of treatment response (ETR) without sustained virological response (SVR), and A2 included 20 patients who achieved SVR. Three patients from A1 had HCC recurrence and no patients from A2 had HCC recurrence. (p = 0.0038; group A1, A2, and B).
The rate of HCC recurrence in LTx patients with DAA therapy was significantly higher with ETR, without SVR, after DAA therapy compared to patients with SVR or patients who did not receive DAA therapy. LTx recipients with HCC receiving DAA therapy requires further studies.
最近出现了一个争议：用直接作用抗病毒（DAA）治疗丙型肝炎病毒（HCV）后，肝细胞癌（HCC）的复发率是否更高？然而，尚未研究接受 DAA 治疗的肝移植（LTx）受者中 HCC 复发的风险。本研究旨在比较接受或未接受 DAA 治疗的 LTx 受者 HCC 复发的发生率。
63 例 HCC 患者接受 LTx。27 例（42.9%）HCV 患者接受 DAA 治疗（A 组），20 例（31.7%）HCV 患者未接受 DAA 治疗（B 组），16 例（25.4%）无 HCV（C 组）。
A 组中有 3 例（11%），B 组中有 1 例（5%），C 组中无 HCC 复发。A、B 和 C 组的 4 年无复发生存率分别为 88.9%、95%和 100%（p=0.37）。A 组进一步分为两组与 B 组比较：A1 组包括 5 例 ETR 但无 SVR 的患者，A2 组包括 20 例获得 SVR 的患者。A1 组中有 3 例患者 HCC 复发，A2 组中无患者 HCC 复发。（p=0.0038；A1、A2 和 B 组）。
与 SVR 患者或未接受 DAA 治疗的患者相比，LTx 患者接受 DAA 治疗后 ETR 但无 SVR 时 HCC 复发率明显更高。需要对接受 DAA 治疗的 HCC LTx 受者进行进一步研究。
