Mount Sinai Medical Center NY, RMTI, Transplantation, NY, NY, USA.
Division of Gastroenterology and Hepatology, Beth Israel, Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
HPB (Oxford). 2022 Jul;24(7):1082-1090. doi: 10.1016/j.hpb.2021.11.018. Epub 2021 Dec 9.
The development of direct-acting antiviral (DAA) therapy has revolutionized HCV management. We present a large national study comparing post-LT outcomes for HBV-HCC vs. HCV-HCC according to DAA era.
Data were collected from OPTN/UNOS Registry. Groups included pre-DAA (January 2003-October 2013) and post-DAA (November2013-January2019) eras. Outcomes for patients with HBV(n = 2000) vs. HCV(n = 18,964) were compared in each era.
In the pre-DAA era, there were significant differences between HBV-versus HCV, including the percentage of Caucasian race, pre-LT and maximum AFP levels <20 ng/mL, MELD-score, complete tumor necrosis, and vascular invasion. In the post-DAA-era, differences were noted in wait time>9 months, the percentage of Caucasian race, pre-LT and AFP(max) levels<20 ng/mL, and MELD-score. In the pre-DAA-era, the 5-and-10 year survival rates were 80.5% and 71% for HBV-HCC, and 69% and 54.4% for HCV-HCC (p < 0.001); in the post-DAA-era, 5-year survival was 83.4% for HBV-HCC and 78.5% for HCV-HCC(p = 0.08). Independent pre-LT predictors of lower survival included recipient and donor age>50yrs, wait-time>9months, higher MELD-score (p < 0.001), AFP level>20 ng/mL, and MC at diagnosis. HCV status did not predict outcome in the post-DAA-era after adjusting for tumor characteristics.
After the introduction of effective DAA-HCV therapy, results of LT for HCV-HCC are significantly improved and are no longer statistically different from results in patients with HBV-HCC.
直接作用抗病毒（DAA）治疗的发展彻底改变了 HCV 的管理方式。我们根据 DAA 时代，进行了一项比较 HBV-HCC 与 HCV-HCC 患者肝移植（LT）后结局的大型全国性研究。
数据来自 OPTN/UNOS 注册中心。研究组包括 DAA 前时代（2003 年 1 月至 2013 年 10 月）和 DAA 后时代（2013 年 11 月至 2019 年 1 月）。比较了 DAA 前时代（n=2000）和 DAA 后时代（n=18964）中 HBV（n=2000）与 HCV（n=18964）患者的结局。
在 DAA 前时代，HBV 与 HCV 之间存在显著差异，包括白种人比例、LT 前和最大 AFP 水平<20ng/mL、MELD 评分、完全肿瘤坏死和血管侵犯。在 DAA 后时代，观察到等待时间>9 个月、白种人比例、LT 前和 AFP（最大）水平<20ng/mL 以及 MELD 评分存在差异。在 DAA 前时代，HBV-HCC 的 5 年和 10 年生存率分别为 80.5%和 71%，而 HCV-HCC 分别为 69%和 54.4%（p<0.001）；在 DAA 后时代，HBV-HCC 的 5 年生存率为 83.4%，而 HCV-HCC 为 78.5%（p=0.08）。LT 前独立的生存率较低的预测因素包括受体和供体年龄>50 岁、等待时间>9 个月、MELD 评分较高（p<0.001）、AFP 水平>20ng/mL 和 MC 诊断时。在调整肿瘤特征后，HCV 状态在后 DAA 时代不再是影响结局的预测因素。
在有效 DAA-HCV 治疗引入后，HCV-HCC 的 LT 结果显著改善，不再与 HBV-HCC 患者的结果存在统计学差异。
