Dados do Trabalho

Título

Treatment with direct-acting antivirals does neither increase the risk of hepatocellular carcinoma progression during waiting list nor recurrence after liver transplantation

Introdução

Treatment with direct-acting antivirals (DAAs) before or after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC) can be associated with tumor progression. We evaluated the association between DAAs and HCC tumor progression during waiting list and post-LT recurrence.

Material e Método

Three cohorts of patients with HCC who were listed for LT were compared: without HCV (n=503), HCV+ untreated with DAAs (n=327) and HCV+ treated with DAAs (n=164). Primary separate end-points were HCC radiological progression during waiting list and post LT recurrence; analyzed by multivariable competing risk regression analysis adjusted by a propensity score matching and inverse probability weighting of DAAs treatment probability.

Resultados

Waiting list time was 6.1 months; 34.1% showed prior competing; 24.2% had tumor progression, 13.4% received DAAs (patients treated with DAAs before LT presented a similar rate of tumor progression when compared with HCV+ without treatment with DAAs (26.2% vs 26.9%);The probability of receiving pre-LT DAAs among HCV+ patients from the pre-LT multivariable logistic model included the following clinical variables: male gender OR 1.88 (CI 0.95; 3.69), year of listing after 2015 OR 5.51 (CI 2.84; 10.7), AFP model >2 points at listing OR 0.81 (CI 0.08;0.73);Cumulative incidence of HCC recurrence was 6.3% (CI 1.5%-19.9%; n=41);Cumulative SHR of HCC recurrence for treated HCV+ patients with DAAs when compared with those not treated after adjusting for the second PS was 0.12 (CI 0.16; 0.88; P=0.038).

Discussão e Conclusões

Treatment of HCV with DAAs is not associated with an increased risk of tumor progression during the waiting list or recurrence after transplantation

Palavras Chave

liver transplantation, HCC, DAAs