Copyright
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Clinical efficacy of direct-acting antiviral therapy for recurrent hepatitis C virus infection after liver transplantation in patients with hepatocellular carcinoma
Mohamed Saleh Ismail, Manal Hassan, Saira Aijaz Khaderi, Wael Ahmed Yousry, Maha Mohsen Kamal El-Din, Mohamed Mohamed Bahaa El-Din, Osama Aboelfotoh El Sayed, Ahmed Omar Kaseb, John Alan Goss, Fasiha Kanwal, Prasun Kumar Jalal
Mohamed Saleh Ismail, Manal Hassan, Saira Aijaz Khaderi, Fasiha Kanwal, Prasun Kumar Jalal, Division of Gastroenterology, Baylor College of Medicine, Houston, TX 77030, United States
Mohamed Saleh Ismail, Wael Ahmed Yousry, Maha Mohsen Kamal El-Din, Osama Aboelfotoh El Sayed, Department of Internal medicine, Gastroenterology and Hepatology, Ain Shams University, Cairo 11566, Egypt
Mohamed Saleh Ismail, Saira Aijaz Khaderi, John Alan Goss, Prasun Kumar Jalal, Department of Surgery, Division of Abdominal Transplantation, Baylor College of Medicine, Houston, TX 77030, United States
Manal Hassan, Department of Epidemiology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Mohamed Mohamed Bahaa El-Din, Department of Surgery, Ain Shams University, Cairo 11566, Egypt
Ahmed Omar Kaseb, Department of Gastrointestinal Medical Oncology, the University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States
Author contributions: Ismail MS designed and performed the research and wrote the paper; Hassan M designed the research and contributed to the analysis; Jalal PK designed and performed the research; Khaderi SA, Yousry WA, Kamal El-Din MM, Bahaa El-Din MM, El Sayed OA, Kaseb AO, Goss JA, Kanwal F interpreted the data and critically supervised the report.
Supported by Ministry of Higher Education, Egypt, No. JS-3787.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Baylor College of Medicine.
Informed consent statement: Informed consent was waived by the Institutional review Board of Baylor College of Medicine.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Mohamed Saleh Ismail, MBChB, MSc, Doctor, Research Fellow, Division of Gastroenterology, Baylor College of Medicine, One Baylor plaza, Houston, TX 77030, United States. mohamed.ismail@bcm.edu
Received: March 9, 2020
Peer-review started: March 9, 2020
First decision: April 3, 2020
Revised: June 3, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 27, 2020
BACKGROUND
Recurrent hepatitis C virus (HCV) infection of transplanted liver allografts is universal in patients with detectable HCV viremia at the time of transplantation. Direct-acting antiviral (DAA) therapy has been adopted as the standard of care for recurrent HCV infection in the post-transplant setting. However, there are insufficient data regarding its efficacy in liver transplant (LT) recipients with a history of hepatocellular carcinoma (HCC), and the risk of HCC recurrence after DAA therapy is unknown.
AIM
To demonstrate predictors of DAA treatment failure and HCC recurrence in LT recipients.
METHODS
A total of 106 LT recipients given DAAs for recurrent HCV infection from 2015 to 2019 were identified (68 with and 38 without HCC). Descriptive statistics and logistic regression models were used to estimate the multivariate odds ratios and respective 95% confidence intervals for predictors of treatment failure and HCC recurrence.
RESULTS
Six patients (6%) experienced DAA therapy failure post-LT and 100 (94%) had a sustained virologic response at follow-up week 12. A high alanine transaminase level > 35 U/L at treatment week 4 was a significant predictor of treatment failure. Relapse to pre-LT DAA therapy is a predictor of post-LT HCC recurrence, P = 0.04. DAA relapse post-LT was also associated with post-transplantation HCC recurrence, P = 0.05.
CONCLUSION
DAAs are effective and safe in the treatment of recurrent HCV infection in LT recipients with history of HCC. Relapse to pre- and post-LT DAA therapy is associated with post-transplantation HCC recurrence.
Core Tip: Our study is the first to find an association between direct-acting antiviral relapse and hepatocellular carcinoma (HCC) recurrence in patients with past history of HCC pre-transplant. Also, our study is the first to highlight high sustained virologic response in patients with past history of HCC after liver transplantation which is similar to patients without past history of HCC as we removed the tumor-harboring liver.
