Tse Chung Sang, Yang Ju Dong, Mousa Omar Y, Nelson Kevin M, Pungpapong Surakit, Keaveny Andrew, Aqel Bashar A, Vargas Hugo, Dickson Rolland C, Watt Kymberly, Gores Gregory J, Roberts Lewis R, Leise Michael D
Division of Gastroenterology, Brown University, Providence, RI.
Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Transplant Direct. 2020 Dec 8;7(1):e635. doi: 10.1097/TXD.0000000000001049. eCollection 2021 Jan.
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).
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.
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%; = 0.07), graft failure (7% versus 3%; = 0.21), or death (12% versus 19%; = 0.19) as compared with DAA naive patients. SVR rates were significantly lower ( < 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.
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.
直接作用抗病毒药物（DAA）对丙型肝炎（HCV）治疗非常有效，尽管关于DAA疗法在等待肝细胞癌（HCC）肝移植的丙型肝炎阳性个体中的安全性和有效性的数据有限。
我们对2014年至2017年在美国3个肝移植中心接受HCC肝移植的HCV阳性患者进行了一项回顾性队列研究，随访至2018年7月。使用Kaplan-Meier分析和Cox比例风险模型，将移植前接受DAA的移植受者与未接受DAA的移植受者（未接受过DAA治疗）在移植后HCC复发率、持续病毒学应答（SVR）、移植失败和死亡方面进行比较。
共纳入171例HCV-HCC移植受者（99例移植前接受DAA；72例未接受过DAA治疗的对照），中位随访时间为24个月。移植后HCC总体复发率为9%（15/171）。与未接受过DAA治疗的患者相比，移植前接受DAA与HCC复发（5%对14%；P = 0.07）、移植失败（7%对3%；P = 0.21）或死亡（12%对19%；P = 0.19）无关。移植前DAA治疗的SVR率（75%，39/52）显著低于移植后DAA治疗（97%，59/61）（P < 0.01）。接受移植前DAA治疗和未接受移植前DAA治疗的患者在年龄、性别、甲胎蛋白水平、终末期肝病模型评分或移植等待时间方面无统计学差异。
HCV移植前DAA与移植后HCC复发风险增加无关，尽管HCV-HCC移植受者中移植前DAA的疗效低于移植后DAA。
