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  3. 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

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:

Autores de IIS La Fe

Participantes ajenos a IIS La Fe

  • Gorgen A.
  • Galvin Z.
  • Huang A.C.
  • O'Rourke J.M.
  • Francoz C.
  • Hansen B.E.
  • Durand F.
  • Elsharkawy A.M.
  • Shah T.
  • Mehta N.
  • Terrault N.A.
  • Lilly L.B.
  • Selzner N.
  • Sapisochin G.

Grupos

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 naïve, 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 naïve 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. © 2022 Wolters Kluwer Health, Inc. All rights reserved.

Datos de la publicación

ISSN/ISSNe:
0041-1337, 1534-6080

TRANSPLANTATION  LIPPINCOTT WILLIAMS & WILKINS

Tipo:
Article
Páginas:
2087-2096
PubMed:
31978002
Enlace a otro recurso:
www.scopus.com
Factor de Impacto:
1,450 SCImago ℠
Cuartil:
Q1 SCImago ℠

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Keywords

  • Antiviral Agents; Carcinoma, Hepatocellular; Female; Hepatitis C; Humans; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Neoplasm Recurrence, Local; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Waiting Lists; antivirus agent; adverse event; clinical trial; comparative study; female; hepatitis C; hospital admission; human; liver cell carcinoma; liver transplantation; liver tumor; male; middle aged; mortality; multicenter study; pathology; retrospective study; risk assessment; risk factor; time factor; treatment outcome; tumor recurrence

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