Background/Aims: Several studies have shown improved outcome of liver transplant (LT) recipients with hepatitis C virus (HCV) since the widespread clinical use of interferon-free direct-acting antivirals (IFN-free DAAs). However, the association of IFN-free DAA therapy on tumor characteristics and on the outcome of LT in patients with hepatocellular carcinoma (HCC) has not been studied. We aimed to examine pre-transplant HCC characteristics and post-LT outcomes in the IFN-based DAA treatment and IFN-free DAA treatment eras.
Methods: Using the United Network for Organ Sharing/Organ Procurement and Transplantation Network database, we analyzed adults with a diagnosis of HCV and HCC who received LTs from deceased donors from 04/2012 to 12/2017. Cox regression models were used to identify the association between the IFN-based DAA treatment vs IFN-free DAA treatment era and study outcomes (mortality, graft failure, and HCC recurrence at 1 and 3 years).
Results: Complete tumor necrosis was significantly higher in the IFN-free DAA treatment era (22.73% vs 18.22%; P < 0.01). No other HCC tumor characteristics differed significantly between the two eras. HCC recurrence rates were similar between the two eras. On multivariate Cox regression analysis, patients who had transplants in the IFN-free DAA treatment era had lower risk of graft failure compared with the IFN-based DAA treatment group (hazard ratio [HR], 0.44; 95% confidence interval [CI], 0.25– 0.77; P < 0.01). Patient mortality was lower in the IFN-free DAA treatment era although the difference was not statistically significant (HR, 0.82; 95% CI, 0.60– 1.13; P =0.22).
Conclusion: LT recipients in the IFN-free DAA treatment era had significantly higher complete tumor necrosis in explants. Other HCC tumor characteristics were similar between the two eras. Post-LT graft failure at 1 and 3 years significantly decreased in the IFN-free DAA treatment era among patients with HCV and HCC, although patient mortality was not statistically different.

Keywords: hepatocellular carcinoma, liver transplantation, hepatitis C virus, direct-acting antiviral


中文翻译：

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丙型肝炎病毒和肝细胞癌患者肝移植后无干扰素直接抗病毒治疗时代的结果

背景/目的：自无干扰素直接作用抗病毒药物（无干扰素的 DAA）在临床上广泛使用以来，多项研究表明，丙型肝炎病毒 (HCV) 肝移植 (LT) 受者的预后有所改善。然而，尚未研究无 IFN 的 DAA 治疗与肝细胞癌 (HCC) 患者的肿瘤特征和 LT 结果的关系。我们旨在检查基于 IFN 的 DAA 治疗和无 IFN 的 DAA 治疗时代的移植前 HCC 特征和 LT 后结果。
方法：使用器官共享联合网络/器官采购和移植网络数据库，我们分析了 2012 年 4 月 4 日至 2017 年 12 月期间从已故捐赠者那里接受 LT 的诊断为 HCV 和 HCC 的成年人。Cox 回归模型用于确定基于 IFN 的 DAA 治疗与无 IFN 的 DAA 治疗时代和研究结果（死亡率、移植失败和 1 年和 3 年 HCC 复发）之间的关联。
结果：无 IFN DAA 治疗时代肿瘤完全坏死率显着升高（22.73% vs 18.22%；P< 0.01)。两个时代之间没有其他 HCC 肿瘤特征有显着差异。两个时代的HCC复发率相似。在多变量 Cox 回归分析中，与基于 IFN 的 DAA 治疗组相比，在无 IFN DAA 治疗时代进行移植的患者移植失败的风险较低（风险比 [HR]，0.44；95% 置信区间 [CI]， 0.25–0.77；P < 0.01)。尽管差异无统计学意义（HR，0.82；95% CI，0.60-1.13；P = 0.22），但无 IFN DAA 治疗时代的患者死亡率较低。
结论：无 IFN DAA 治疗时代的 LT 受者在外植体中具有显着更高的完全肿瘤坏死。两个时代的其他 HCC 肿瘤特征相似。在 HCV 和 HCC 患者中，在无 IFN DAA 治疗时代，LT 后 1 年和 3 年的移植失败显着降低，尽管患者死亡率没有统计学差异。

关键词：肝细胞癌，肝移植，丙型肝炎病毒，直接抗病毒药物