• Michael K Turgeon, Shimul A Shah, Aaron M Delman, Benjamin V Tran, Vatche G Agopian, Joel P Wedd, Joseph F Magliocca, Ahyoung Kim, Andrew Cameron, Ali Olyaei, Susan L Orloff, Matthew P Anderson, Chandrashekhar A Kubal, Robert M Cannon, Jayme E Locke, Mary A Simpson, Mohamed E Akoad, Chelsey P Wongjirad, Juliet Emamaullee, Amika Moro, Federico Aucejo, Cyrus A Feizpour, Parsia A Vagefi, Mindie H Nguyen, Carlos O Esquivel, Kiran Dhanireddy, Vijay Subramanian, Alejandro Chavarriaga, Marwan M Kazimi, Maia S Anderson, Christopher J Sonnenday, Steven C Kim, David P Foley, Marwan Abdouljoud, Reena J Salgia, Dimitrios Moris, Debra L Sudan, Swaytha R Ganesh, Abhinav Humar, Majella Doyle, William C Chapman, and Shishir K Maithel.
• Emory University, Atlanta, Georgia.
• Ann. Surg. 2021 Oct 1; 274 (4): 613620613-620.

ObjectiveTo investigate the optimal timing of direct acting antiviral (DAA) administration in patients with hepatitis C-associated hepatocellular carcinoma (HCC) undergoing liver transplantation (LT).Summary Of Background DataIn patients with hepatitis C (HCV) associated HCC undergoing LT, the optimal timing of direct-acting antivirals (DAA) administration to achieve sustained virologic response (SVR) and improved oncologic outcomes remains a topic of much debate.MethodsThe United States HCC LT Consortium (2015-2019) was reviewed for patients with primary HCV-associated HCC who underwent LT and received DAA therapy at 20 institutions. Primary outcomes were SVR and HCC recurrence-free survival (RFS).ResultsOf 857 patients, 725 were within Milan criteria. SVR was associated with improved 5-year RFS (92% vs 77%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 92%, and 82%, and 5-year RFS of 93%, 94%, and 87%, respectively. Among 427 HCV treatment-naïve patients (no previous interferon therapy), patients who achieved SVR with DAAs had improved 5-year RFS (93% vs 76%, P < 0.01). Patients who received DAAs pre-LT, 0-3 months post-LT, and ≥3 months post-LT had SVR rates of 91%, 93%, and 78% (P < 0.01) and 5-year RFS of 93%, 100%, and 83% (P = 0.01).ConclusionsThe optimal timing of DAA therapy appears to be 0 to 3 months after LT for HCV-associated HCC, given increased rates of SVR and improved RFS. Delayed administration after transplant should be avoided. A prospective randomized controlled trial is warranted to validate these results.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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