Lim Nicholas, Singh Dupinder, Jackson Scott, Lake John R
Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA.
Fairview Health Services, Minneapolis, Minnesota, USA.
Gastrointest Tumors. 2020 Oct;7(4):134-143. doi: 10.1159/000510341. Epub 2020 Sep 14.
Direct-acting antivirals (DAAs) have revolutionized the treatment of hepatitis C virus (HCV). The impact of DAAs on recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) remains uncertain.
We aimed to evaluate the risk of HCC recurrence in LT recipients cleared of HCV with DAAs at the time of LT compared to a control group of LT recipients who were viremic at the time of LT.
The study was a single-center, retrospective cohort study of patients undergoing LT for HCV-related HCC from 2002 to 2017. We compared time to post-LT HCC recurrence in patients with a sustained virological response (SVR) from DAAs prior to LT (DAA group) to patients who were viremic at LT (HCV+ group) using Kaplan-Meier analysis. We performed a secondary analysis comparing post-LT HCC recurrence in the DAA group to LT recipients with SVR from interferon-based treatment prior to LT (IFN group).
One hundred fifty-one patients underwent LT for HCC related to HCV: 34 patients in DAA group, 95 patients in HCV+ group, and 22 in IFN group. Kaplan-Meier estimates of being HCC free were 96.2, 96.2, and 78.8% at 6, 12, and 24 months in DAA group, respectively, and 100, 98.6, and 95.8% at 6, 12, and 24 months in the HCV+ group, respectively; = 0.08. There was no difference observed for HCC recurrence between the DAA and IFN groups. In a multivariate Cox proportional hazards model, DAA use increased the risk of post-LT HCC recurrence (HR 5.2, 95% CI 0.9-29.81, = 0.07).
A strong trend was observed on both Kaplan-Meier and multivariate analyses toward increased post-LT HCC recurrence in patients who achieved SVR prior to LT with DAAs compared to patients who were viremic at LT. Caution is required when considering pre-LT treatment of HCV with DAAs in patients with HCC.
直接作用抗病毒药物（DAAs）彻底改变了丙型肝炎病毒（HCV）的治疗方式。DAAs对肝移植（LT）后肝细胞癌（HCC）复发的影响仍不确定。
我们旨在评估与LT时病毒血症的LT受者对照组相比，LT时用DAAs清除HCV的LT受者中HCC复发的风险。
该研究是一项单中心回顾性队列研究，研究对象为2002年至2017年因HCV相关HCC接受LT的患者。我们使用Kaplan-Meier分析比较了LT前DAAs治疗获得持续病毒学应答（SVR）的患者（DAA组）与LT时病毒血症患者（HCV+组）LT后HCC复发的时间。我们进行了一项二次分析，比较了DAA组与LT前基于干扰素治疗获得SVR的LT受者（IFN组）LT后HCC的复发情况。
151例患者因HCV相关HCC接受了LT：DAA组34例，HCV+组95例，IFN组22例。DAA组在6、12和24个月时无HCC的Kaplan-Meier估计值分别为96.2%、96.2%和78.8%，HCV+组在6、12和24个月时分别为100%、98.6%和95.8%；P = 0.08。DAA组和IFN组之间HCC复发情况无差异。在多变量Cox比例风险模型中，使用DAA增加了LT后HCC复发的风险（风险比5.2，95%置信区间0.9 - 29.81，P = 0.07）。
在Kaplan-Meier分析和多变量分析中均观察到一个明显趋势，即与LT时病毒血症的患者相比，LT前用DAAs获得SVR的患者LT后HCC复发增加。对于HCC患者考虑在LT前用DAAs治疗HCV时需谨慎。
