Liver transplant for hepatocellular carcinoma in the United States: Evolving trends over the last three decades.

Journal Article (Journal Article)

Hepatitis C virus infection has been the most common etiology in HCC-related liver transplantation (LT). Since 2014, direct-acting antivirals (DAAs) have dramatically improved HCV cure. We aimed to study the changing pattern of etiologies and impact in outcome in HCC-related LT according to HCV treatment-era through retrospective analysis of the Scientific Registry of Transplant Recipients (SRTR) database (1987-2017). A total of 27 855 HCC-related liver transplants were performed (median age 59 years, 77% male). In the DAA era (2014-2017) there has been a 14.6% decrease in LT for HCV-related HCC; however, HCV remains the most common etiology in 50% of cases. In the same era, there has been a 50% increase in LT for NAFLD-related HCC. Overall survival was significantly worse for HCV-related HCC compared to NAFLD-related HCC during pre-DAA era (2002-2013; P = .031), but these differences disappeared in the DAA era. In addition, HCV patients had a significant improvement in survival when comparing the DAA era with IFN era (P < .001). Independent predictors of survival were significantly different in the pre-DAA era (HCV, AFP, diabetes) than in the DAA era (tumor size). HCV-related HCC continues to be the main indication for LT in the DAA era, but patients' survival has significantly improved and is comparable to that of NAFLD-related HCC.

Full Text

Duke Authors

Cited Authors

  • Puigvehí, M; Hashim, D; Haber, PK; Dinani, A; Schiano, TD; Asgharpour, A; Kushner, T; Kakked, G; Tabrizian, P; Schwartz, M; Gurakar, A; Dieterich, D; Boffetta, P; Friedman, SL; Llovet, JM; Saberi, B

Published Date

  • January 2020

Published In

Volume / Issue

  • 20 / 1

Start / End Page

  • 220 - 230

PubMed ID

  • 31437349

Pubmed Central ID

  • PMC6940543

Electronic International Standard Serial Number (EISSN)

  • 1600-6143

Digital Object Identifier (DOI)

  • 10.1111/ajt.15576

Language

  • eng

Conference Location

  • United States