Optimal Timing of Administration of Direct-acting Antivirals for Patients With Hepatitis C-associated Hepatocellular Carcinoma Undergoing Liver Transplantation.
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Turgeon Michael K, Shah Shimul A, Delman Aaron M, Tran Benjamin V, Agopian Vatche G, Wedd Joel P, Magliocca Joseph F, Kim Ahyoung, Cameron Andrew, Olyaei Ali, Orloff Susan L, Anderson Matthew P, Kubal Chandrashekhar A, Cannon Robert M, Locke Jayme E, Simpson Mary A, Akoad Mohamed E, Wongjirad Chelsey P, Emamaullee Juliet, Moro Amika, Aucejo Federico, Feizpour Cyrus A, Vagefi Parsia A, Nguyen Mindie H, Esquivel Carlos O, Dhanireddy Kiran, Subramanian Vijay, Chavarriaga Alejandro, Kazimi Marwan M, Anderson Maia S, Sonnenday Christopher J, Kim Steven C, Foley David P, Abdouljoud Marwan, Salgia Reena J, Moris Dimitrios, Sudan Debra L, Ganesh Swaytha R, Humar Abhinav, Doyle Majella, Chapman William C, Maithel Shishir K
Аннотация
SUMMARY OF BACKGROUND DATA: In patients with hepatitis C (HCV) associated HCC undergoing LT, the optimal timing of direct-acting antivirals (DAA) administration to achieve sustained virologic response (SVR) and improved oncologic outcomes remains a topic of much debate.
METHODS: The United States HCC LT Consortium (2015-2019) was reviewed for patients with primary HCV-associated HCC who underwent LT and received DAA therapy at 20 institutions. Primary outcomes were SVR and HCC recurrence-free survival (RFS).
RESULTS: Of 857 patients, 725 were within Milan criteria. SVR was associated with improved 5-year RFS (92% vs 77%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 92%, and 82%, and 5-year RFS of 93%, 94%, and 87%, respectively. Among 427 HCV treatment-naïve patients (no previous interferon therapy), patients who achieved SVR with DAAs had improved 5-year RFS (93% vs 76%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 93%, and 78% (P < 0.01) and 5-year RFS of 93%, 100%, and 83% (P = 0.01).
CONCLUSIONS: The optimal timing of DAA therapy appears to be 0 to 3 months after LT for HCV-associated HCC, given increased rates of SVR and improved RFS. Delayed administration after transplant should be avoided. A prospective randomized controlled trial is warranted to validate these results.