Abstract
Background The introduction of direct-acting antivirals (DAA) for HCV has led to high rates of HCV eradication. Treatment of patients awaiting liver transplantation (LT) has been controversial. Recent data suggests that DAA treatment may accelerate recurrent HCC. The impact of DAA on delisting for HCC progression or recurrent HCC post-LT has not been well characterized. Methods A retrospective review of both waitlist patients and LT recipients at a single institution was performed. Patient demographics, HCV treatment, HCC features and treatments, biopsy results, and graft and patient survival were evaluated. Patients on the LT waitlist or who were transplanted between January 2014 and December 2015 were included. Data was collected through December 2017 to have a minimum of two years of follow-up. Results In the study period, 128 adult LT were performed. 44 patients were HCV+, and 68.2% (N=30) also had HCC. 38.6% (N=17) of HCV+ patients received DAA pre-LT, and 94.1% (N=16/17) achieved sustained virologic response (SVR) pre-LT. Among untreated HCV+ patients who underwent LT, 81.5% (N=22/27) received DAA post-LT, with 82.6% achieving SVR post-LT (N=18/22). 82.1% (N=23/28) of untreated post-LT patients underwent liver biopsy prior to therapy, and 52.2% had at least F1 METAVIR fibrosis. 87.5% (N=14/16) of active waitlist patients received DAA and achieved SVR. HCV eradication did not result in higher rates of delisting for HCC progression. Due to local HCC listing criteria of total tumor volume and AFP, 60% (N=18/30) of HCV+/HCC patients were beyond Milan criteria at the time of LT. Despite this, there was no difference in HCC recurrence rates post-LT, whether patients achieved SVR pre- or post-LT. Conclusions These data suggest that HCV eradication pre-LT does not significantly impact waitlist time for HCV+ patients with HCC. HCV eradication does not impact rates of delisting for HCC progression or rates of HCC recurrence post-LT.
Highlights
Hepatitis C virus (HCV) infection continues to create a significant global health burden, with an estimated 185 million carriers worldwide
This study represents the first North American, single institution experience characterizing the impact of HCV eradication with direct-acting antivirals (DAA) on patients with HCV and hepatocellular carcinoma (HCC) on the liver transplantation (LT) waiting list and in LT recipients [17]
These data demonstrate that HCV eradication with DAA prior to LT can result in sustained virologic response (SVR) in a high proportion of patients on the waiting list and does not impact mean waiting time, when a majority of the patients are receiving Model of End Stage Liver Disease (MELD) exception points for HCC (Tables 1 and 2)
Summary
Hepatitis C virus (HCV) infection continues to create a significant global health burden, with an estimated 185 million carriers worldwide. Recent advances in the development of direct-acting antiviral (DAA) treatment of HCV have led to high rates of HCV eradication, even in patients with decompensated cirrhosis [4]. Recent data has shown that DAA regimens such as sofosbuvir and velpatasvir can result in very high rates of sustained virologic response (SVR) in 78-94% in patients with decompensated cirrhosis, depending on the HCV genotype [4, 6]. There has been data to suggest that HCV eradication with DAA may accelerate early recurrent HCC [10,11,12]. These data suggest that HCV eradication pre-LT does not significantly impact waitlist time for HCV+ patients with HCC. HCV eradication does not impact rates of delisting for HCC progression or rates of HCC recurrence post-LT
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.