The Impact of Direct-acting Antivirals on Overall Mortality and Tumoral Recurrence in Patients With Hepatocellular Carcinoma Listed for Liver Transplantation: An International Multicenter Study

Fecha de publicación: 01/10/2020

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

Gorgen, A
Galvin, Z
Huang, AC
O'Rourke, JM
Francoz, C
Hansen, BE
Durand, F
Elsharkawy, AM
Shah, T
Mehta, N
Terrault, NA
Lilly, LB
Selzner, N
Sapisochin, G

Grupos

Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

Leader

Marina Berenguer Haym

Abstract

Background. There is a lack of data on the use of direct-acting antivirals (DAA) on the risk of death and tumoral recurrence in patients with hepatitis C virus (HCV) and hepatocellular carcinoma (HCC) listed for liver transplantation (LT). We aimed to assess the impact of antiviral treatment on mortality and HCC recurrence patients with HCC-HCV. Methods. This was a retrospective multicenter study of patients with HCC-HCV listed for LT from 2005 to 2015. Patients were divided according to the antiviral treatment received after HCC diagnosis: DAA, interferon (IFN), or no antiviral. Intention-to-treat overall survival and HCC recurrence incidence were compared by the Kaplan-Meier method. Multivariable regression analysis was performed to identify risk factors for outcomes. Results. A total of 1012 HCV-HCC patients were listed for LT during the study period. The median follow-up was 4.0 (interquartile range = 2.3-6.7) years. Mortality was 5.6 (95% confidence interval [CI], 4.3-7.2), 13.1 (95% CI, 11.0-15.7), and 6.2 (95% CI, 5.4-7.2) deaths per 100 person-year among patients treated with DAA, IFN, and antiviral naive, respectively (P< 0.001). Of the 875 HCV-HCC transplant recipients, the 5-year recurrence-free survival was 93.4%, 84.8%, 73.9% for the pre-LT DAA, pre-LT IFN, and antiviral naive groups, respectively (P< 0.001). After multivariable regression, the use of pre-LT DAA was not associated to risk of recurrence (hazard ratio = 0.44 [95% CI, 0.19-1.00]). Post-LT DAA was not related to increased risk of recurrence (hazard ratio = 0.62 [95% CI, 0.33-1.16]). Conclusions. In this multicenter intent-to-treat study, DAA therapy was not found to be a risk factor for mortality or HCC recurrence after adjusting for potential confounders.

Datos de la publicación

ISSN/ISSNe:: 0041-1337, 1534-6080
Tipo:: Article
Páginas:: 2087-2096
DOI:: 10.1097/TP.0000000000003115
Factor de Impacto:: 1,450 SCImago ℠
Cuartil:: Q1 SCImago ℠

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Filiaciones

Gorgen, A:: Univ Hlth Network, Toronto Gen Hosp, Dept Gen Surg, Multiorgan Transplant Program, Toronto, ON, Canada

Univ Hlth Network, Toronto Gen Hosp, Gen Surg Dept, Toronto, ON, Canada
Galvin, Z:: Univ Hlth Network, Toronto Gen Hosp, Dept Gen Surg, Multiorgan Transplant Program, Toronto, ON, Canada

Univ Hlth Network, Toronto Gen Hosp, Dept Med, Toronto, ON, Canada
Huang, AC:: Univ Calif San Francisco, Dept Med, Div Gastroenterol Hepatol, San Francisco, CA 94143 USA
Vinaixa, C:: Instituto de Investigación. Univ Valencia, Hosp Univ & Politecn La Fe, Dept Surg, Ciberehd,IISLaFe,Hepatol & Liver Transplantat Uni, Valencia, Spain
O'Rourke, JM:: NHS Fdn Trust, Univ Hosp Birmingham, NIHR Birmingham Biomed Res Ctr, Birmingham, W Midlands, England

Univ Birmingham, Birmingham, W Midlands, England
Francoz, C:: Hop Beaujon, Serv Hepatol, Clichy, France
Hansen, BE:: Univ Toronto, Inst Hlth Policy Management & Evaluat, Toronto, ON, Canada

Toronto Gen Hosp, Toronto Ctr Liver Dis, Dept Med, Toronto, ON, Canada
Durand, F:: Hop Beaujon, Serv Hepatol, Clichy, France
Elsharkawy, AM:: NHS Fdn Trust, Univ Hosp Birmingham, NIHR Birmingham Biomed Res Ctr, Birmingham, W Midlands, England

Univ Birmingham, Birmingham, W Midlands, England
Shah, T:: NHS Fdn Trust, Univ Hosp Birmingham, NIHR Birmingham Biomed Res Ctr, Birmingham, W Midlands, England

Univ Birmingham, Birmingham, W Midlands, England
Berenguer, M:: Instituto de Investigación. Univ Valencia, Hosp Univ & Politecn La Fe, Dept Surg, Ciberehd,IISLaFe,Hepatol & Liver Transplantat Uni, Valencia, Spain
Rubin, A:: Instituto de Investigación. Univ Valencia, Hosp Univ & Politecn La Fe, Dept Surg, Ciberehd,IISLaFe,Hepatol & Liver Transplantat Uni, Valencia, Spain
Calatayud, D:: Instituto de Investigación. Univ Valencia, Hosp Univ & Politecn La Fe, Dept Surg, Ciberehd,IISLaFe,Hepatol & Liver Transplantat Uni, Valencia, Spain
Mehta, N:: Univ Calif San Francisco, Dept Med, Div Gastroenterol Hepatol, San Francisco, CA 94143 USA
Terrault, NA:: Univ Calif San Francisco, Dept Med, Div Gastroenterol Hepatol, San Francisco, CA 94143 USA
Lilly, LB:: Univ Hlth Network, Toronto Gen Hosp, Dept Gen Surg, Multiorgan Transplant Program, Toronto, ON, Canada

Univ Hlth Network, Toronto Gen Hosp, Dept Med, Toronto, ON, Canada
Selzner, N:: Univ Hlth Network, Toronto Gen Hosp, Dept Gen Surg, Multiorgan Transplant Program, Toronto, ON, Canada

Univ Hlth Network, Toronto Gen Hosp, Dept Med, Toronto, ON, Canada
Sapisochin, G:: Univ Hlth Network, Toronto Gen Hosp, Dept Gen Surg, Multiorgan Transplant Program, Toronto, ON, Canada

Univ Hlth Network, Toronto Gen Hosp, Gen Surg Dept, Toronto, ON, Canada