Optimal Timing of Administration of Direct-acting Antivirals for Patients With Hepatitis C-associated Hepatocellular Carcinoma Undergoing Liver Transplantation.
OBJECTIVE: To investigate the optimal timing of direct acting antiviral (DAA) administration in patients with hepatitis C-associated hepatocellular carcinoma (HCC) undergoing liver transplantation (LT). 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.
Turgeon, MK; Shah, SA; Delman, AM; Tran, BV; Agopian, VG; Wedd, JP; Magliocca, JF; Kim, A; Cameron, A; Olyaei, A; Orloff, SL; Anderson, MP; Kubal, CA; Cannon, RM; Locke, JE; Simpson, MA; Akoad, ME; Wongjirad, CP; Emamaullee, J; Moro, A; Aucejo, F; Feizpour, CA; Vagefi, PA; Nguyen, MH; Esquivel, CO; Dhanireddy, K; Subramanian, V; Chavarriaga, A; Kazimi, MM; Anderson, MS; Sonnenday, CJ; Kim, SC; Foley, DP; Abdouljoud, M; Salgia, RJ; Moris, D; Sudan, DL; Ganesh, SR; Humar, A; Doyle, M; Chapman, WC; Maithel, SK
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