Risk of hepatocellular carcinoma recurrence in liver transplant recipients following treatment of hepatitis C with direct-acting antivirals.

[INTRODUCTION] Data on the risk of hepatocellular carcinoma (HCC) recurrence in a transplanted liver following direct‑acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection are sparse and inconsistent.

[OBJECTIVES] This study aimed to evaluate the safety and efficacy of DAA treatment in patients with a history of orthotopic liver transplant (OLTx) performed due to HCV‑related cancer, and to assess the risk of HCC recurrence.

[PATIENTS AND METHODS] This real‑world retrospective study included all consecutive patients with chronic hepatitis C who underwent LTx for HCV‑related HCC before DAA therapy. Treatment efficacy (measured by sustained virologic response) and patient outcomes (adverse events, mortality, HCC recurrence) were assessed during treatment, 12 weeks after treatment completion, and in long‑term follow‑up.

[RESULTS] The analyzed population included 58 patients at a median (interquartile range [IQR]) age of 59 (53-63) years; predominantly men (70.7%). The majority of patients had comorbidities (83%) and were infected with the genotype 1b of HCV (86.2%). Less than half of the population was treatment‑experienced. The median (IQR) time from OLTx to DAA initiation was 19.5 (9.8-36) months. Twelve patients had cirrhosis at the start of DAA therapy, including 4 with decompensated cirrhosis. Ttreatment effectiveness was 98.2%, with no differences according to the stage of fibrosis, time since OLTx, and type of DAA regimen used. During a median (IQR) long‑term follow‑up of 8 (6-9) years, 3 patients (5.4%) developed recurrent HCC in the transplanted liver; one during DAA therapy, one 12 weeks after treatment initiation, and one 2 years after the DAA therapy completion. All these patients died from liver cancer dissemination.

[CONCLUSIONS] DAA therapy in patients who received antiviral treatment after OLTx performed due to HCV‑related HCC was highly effective, and the long‑term HCC recurrence rate was 5.4%, which is lower than expected based on the natural history of the disease.