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
ARTICLE HIGHLIGHTS
Research background
Recent studies have shown lower sustained virologic response in patients with hepatocellular carcinoma (HCC) pre-transplant. Moreover, there are conflicting data regarding HCC recurrence in patients treated with direct-acting antivirals (DAAs). However, there are insufficient data regarding the efficacy of DAA in liver transplant (LT) recipients with past history of HCC.
Research motivation
To identify risk factors for DAA relapse and HCC recurrence after LT.
Research objectives
To highlight the efficacy and safety of DAA therapy in LT recipients with hepatitis C virus infections and history of HCC and to investigate the impact of DAA use on post-transplantation HCC recurrence.
Research methods
We retrospectively analyzed the data of our center of LT recipients who received DAA therapy for hepatitis C virus recurrence and their relapse and HCC recurrence outcomes.
Research results
Six patients (6%) experienced DAA therapy failure post-LT and 100 (94%) had a sustained virologic response at follow-up week 12. DAA relapse post-LT was associated with post-transplantation HCC recurrence, P = 0.05. Pre-LT DAA relapse is a predictor of post-LT HCC recurrence, P = 0.04.
Research conclusions
DAA is safe and effective in LT recipients with history of HCC. High alanine aminotransferase > 35 U/L at treatment week 4 and pre-LT DAA relapse are predictors of HCC recurrence after transplant. Relapse to DAA therapy post-LT is a potential risk factor for HCC recurrence.
Research perspectives
Performing a multicenter study of a larger sample to validate our findings.
