直接作用抗病毒治疗时代丙型肝炎病毒相关肝细胞癌肝移植结局的改善。

Improving Liver Transplant Outcomes for Hepatitis C Virus Hepatocellular Carcinoma in the Direct-Acting Antiviral Therapy Era.

机构信息

Department of Surgery, Westchester Medical Center/New York Medical College, Valhalla, New York.

出版信息

Transplant Proc. 2022 Sep;54(7):1834-1838. doi: 10.1016/j.transproceed.2022.03.070. Epub 2022 Aug 4.

DOI:10.1016/j.transproceed.2022.03.070

PMID:35933231

Abstract

BACKGROUND

Direct-acting antiviral (DAA) therapy has transformed the outcomes of liver transplant (LT) with hepatitis C virus (HCV). This study aimed to analyze the effects of DAA treatment for HCV-associated hepatocellular carcinoma (HCC) in LT.

METHODS

We included patients confirmed with HCC on explant, analyzed data from United Network for Organ Sharing, and defined the pre-DAA era (2012-2013) and DAA era (2014-2016).

RESULTS

HCV-associated HCC cases totaled 4778 (62%) during the study period. In the DAA era, the median recipient age was older and the median days on the waiting list were longer. For the donor, median age, body mass index, and the rate of HCV significantly increased in the DAA era. In pathology, the median largest tumor size was significantly higher; however, the rate of completed tumor necrosis was significant higher in the DAA era. The 3-year graft/patient survival had significantly improved in the DAA era. In multivariable analysis, the DAA era (hazard ratio, 0.79; 95% confidence interval, 0.68-0.91) had significantly affected the 3-year graft survival.

CONCLUSIONS

DAA has a significant beneficial effect on LT. In the DAA era, graft survival for HCV-associated HCC has been significantly improving.

摘要

背景

直接作用抗病毒（DAA）治疗改变了丙型肝炎病毒（HCV）肝移植（LT）的结局。本研究旨在分析 DAA 治疗对 LT 中 HCV 相关肝细胞癌（HCC）的影响。

方法

我们纳入了在肝移植中经活检证实的 HCC 患者，分析了来自美国器官共享网络的数据，并定义了 DAA 治疗前时代（2012-2013 年）和 DAA 时代（2014-2016 年）。

结果

研究期间，HCV 相关 HCC 病例总计 4778 例（62%）。在 DAA 时代，受体的中位年龄较大，等待名单上的中位天数较长。对于供体，中位年龄、体重指数和 HCV 阳性率在 DAA 时代明显增加。在病理学方面，中位最大肿瘤大小显著升高；然而，DAA 时代肿瘤坏死完成率显著升高。DAA 时代 3 年移植物/患者存活率显著提高。多变量分析显示，DAA 时代（风险比，0.79；95%置信区间，0.68-0.91）显著影响 3 年移植物存活率。