Risk of hepatocellular carcinoma recurrence after liver transplantation and treatment of hepatitis C with direct-acting antivirals

Introduction: Data on the risk of hepatocellular carcinoma (HCC) recurrence in transplanted liver after direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection are sparse and inconsistent.

Objectives: This study aimed to evaluate the DAA treatment in patients after orthotopic liver transplantation (OLTx), 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 liver transplantation for HCV-related HCC before DAA therapy.

Results: The analyzed population consisted of 58 patients at a median age of 59 years; they were predominantly male (70.7%). The majority of patients had comorbidities (83%) and were infected with GT1b (86.2%). Less than half of the population was treatment-experienced. The median time from OLTx to DAA initiation was 19.5 months. Twelve patients had a diagnosis of cirrhosis at the start of DAA therapy, including four with decompensated cirrhosis. The treatment effectiveness was 98.2% with no differences according to the stage of fibrosis, the time since OLTx, and the type of DAA regimen used. During a median long-term follow-up of 8 years, three patients (5.4%) developed recurrence of HCC in the transplanted liver, one during therapy, one 12 weeks after treatment, and one two years after DAA therapy. All died from liver cancer dissemination.

Conclusions: DAA therapy in patients who received antiviral treatment after OLTx for 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.