The Impact of Direct Acting Antivirals on Overall Mortality and Tumoral Recurrence in Patients with Hepatocellular Carcinoma Listed for Liver Transplantation.: An International Multicenter Study

BACKGROUND: There is lack of data on the use of direct-acting antivirals (DAA) on the risk of death and tumoral recurrence in patients with hepatitis C (HCV) and hepatocellular carcinoma (HCC) listed for liver transplantation (LT). We aimed to assess the impact of antiviral treatment on mortality and HCC recurrence patients with HCC-HCV. METHODS: This was a retrospective multicenter study of patients with HCC-HCV listed for LT from 2005 to 2015. Patients were divided according to the antiviral treatment received after HCC diagnosis: DAA, interferon (IFN) or no antiviral. Intention-to-treat overall survival and HCC recurrence incidence were compared by the Kaplan Meier method. Multivariable regression analysis was performed to identify risk factors for outcomes. RESULTS: 1012 HCV-HCC patients were listed for LT during the study period. The median follow-up was 4.0 (IQR 2.3-6.7) years. Mortality was 5.6 (95%CI 4.3-7.2), 13.1 (95%CI 11.0-15.7) and 6.2 (95%CI 5.4-7.2) deaths per 100 person-year among patients treated with DAA, IFN and antiviral naive, respectively (p<0.001). Of the 875 HCV-HCC transplant recipients, the 5-year recurrence-free survival was 93.4%, 84.8%, 73.9% for the pre-LT DAA, pre-LT IFN and antiviral naive groups, respectively (p<0.001). After multivariable regression, the use of pre-LT DAA was not associated to risk of recurrence [HR=0.44 (95%CI 0.19-1.00)]. Post-LT DAA was not related to increased risk of recurrence [HR=0.62 (95% CI 0.33-1.16)]. CONCLUSIONS: In this multicenter intent-to-treat study, DAA therapy was not found to be a risk factor for mortality or HCC recurrence after adjusting for potential confounders.