"Direct‐acting antivirals and hepatocellular carcinoma: no evidence of higher waitlist progression or post‐transplant recurrence"

The association between direct-acting antivirals (DAAs) and hepatocellular carcinoma (HCC) waitlist progression or its recurrence following liver transplantation (LT) remains uncertain. We evaluated the impact of DAAs on HCC waitlist progression and post-LT recurrence. This Latin American multicenter retrospective cohort study included HCC patients listed for LT between 2012-2018. Patients were grouped according to etiology of liver disease: HCV(-), HCV(+) never treated with DAAs and HCV(+) treated with DAAs either before or after transplantation. Multivariable competing risk models were conducted for both, HCC waitlist progression adjusted by a propensity score matching (pre-LT DAAs effect) and for post-LT HCC recurrence (pre or post LT DAAs effect). From 994 included patients, 50.6% were HCV-, 32.9% were HCV+ never treated with DAAs and 16.5% were HCV+ treated with DAAs either before (n=66) or after LT (n=98). Patients treated with DAAs before LT presented similar cumulative incidence of waitlist tumor progression when compared with those HCV+ without DAAs (26.2% vs 26.9%; P=0.47) and a similar HCC related drop-out rate [12.1% (CI 0.4-8.1%) versus 12.9% (CI 3.8-27.2%)], adjusted for baseline tumor burden, AFP values, HCC diagnosis after listing, bridging therapies and by the probability of having received or not DAAs through a propensity score matching [SHR 0.9 (CI 0.6; 1.6); P=0.95]. A lower incidence of post-transplant HCC recurrence among HCV+ treated with pre or post-LT DAAs was observed [0.7% (CI 0.2-4.0%)]; however, this effect was confounded by time to DAAs initiation after LT. In conclusion, in this multicenter cohort, HCV treatment with DAAs did not appear to be associated with an increased waitlist tumor progression and HCC recurrence after LT.