Background: Recent advances in the direct-acting antiviral (DAA) treatment of HCV have lead to high rates of HCV eradication, even in patients with decompensated cirrhosis. Due to the cost of these therapies, treatment of patients awaiting liver transplantation has been controversial. Recently, there has been data to suggest that DAA treatment may accelerate recurrent hepatocellular carcinoma (HCC). In this study, a retrospective review of HCV⁺ patients in our liver transplant program was performed, focusing on rates of HCV eradication pre- and post-transplant, its impact on post-transplant outcomes, and the rates of HCC recurrence in HCV+ recipients.

Methods: A retrospective review of patients who underwent liver transplantation between January 2014 and December 2015 was performed. Patient demographics, HCV treatment, HCC features and treatments, biopsy results, and graft and patient survival were evaluated. Patients on the waiting list were also reviewed.

Results: In the study period, 128 adult liver transplants were performed. 44 patients were HCV+, while 68% also had a diagnosis of HCC. In 2014, only 18.2% of HCV+ patients were treated with DAA and achieved sustained virologic response (SVR) prior to transplant, while 54.5% of HCV+ patients achieved SVR pre-transplant in 2015 (p<0.05). 76.5% of HCV+ patients achieved SVR post-transplant (mean 473.6 days). 89% of patients treated with DAA post-transplant required liver biopsy, and 52.1% had at least F1 METAVIR fibrosis. There were two deaths related to fibrosing cholestatic hepatitis post-transplant. HCV eradication pre-transplant did not impact mean waiting time or MELD at the time of transplant. On the waitlist, 94.4% of HCV+ patients were treated with DAA, and 76.5% achieved SVR. HCV eradication prior to transplant did not result in higher rates of delisting for HCC progression. 60% of HCV+ patients transplanted with HCC were beyond Milan criteria at the time of transplant. Despite this, there was no difference in HCC recurrence rates post-transplant, whether HCV+ patients achieved SVR pre- or post-transplant.

Conclusions: These data suggest that HCV eradication should be attempted pre-transplant and does not significantly impact waitlist time or MELD for HCV+ patients. HCV eradication can be achieved in a majority of patients pre-transplant and does not impact rates of delisting for HCC progression or rates of HCC recurrence post-transplant.

CITATION INFORMATION: Emamaullee J, Bral M, Meeberg G, Montano-Loza A, Bain V, Bigam D, Kneteman N, Shapiro A. HCV Eradication with DAA Therapy Should Be Attempted Prior to Liver Transplantation and Does Not Impact HCC Recurrence. Am J Transplant. 2017;17 (suppl 3).

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