Liver transplant for hepatocellular carcinoma in the United States: evolving trends over the last three decades

Hashim, Dana; Haber, Philipp K.; Dinani, Amreen; Schiano, Thomas D.; Asgharpour, Amon; Kushner, Tatyana; Kakked, Gaurav; Tabrizian, Parissa; Schwartz, Myron; Gurakar, Ahmet; Dieterich, Douglas; Boffetta, Paolo; Friedman, Scott L.; Llovet, Josep Maria; Saberi, Behnam

doi:http://dx.doi.org/10.1111/ajt.15576

Liver transplant for hepatocellular carcinoma in the United States: evolving trends over the last three decades

Citation

Puigvehí M, Hashim D, Haber PK, Dinani A, Schiano TD, Asgharpour A, et al. Liver transplant for hepatocellular carcinoma in the United States: evolving trends over the last three dècades. Am J Transplant. 2020 Jan; 20(1): 220-30. DOI: 10.1111/ajt.15576

Abstract

Hepatitis C virus infection has been the most common etiology in HCC-related liver transplantation (LT). Since 2014, direct-acting antivirals (DAAs) have dramatically improved HCV cure. We aimed to study the changing pattern of etiologies and impact in outcome in HCC-related LT according to HCV treatment-era through retrospective analysis of the Scientific Registry of Transplant Recipients (SRTR) database (1987-2017). A total of 27 855 HCC-related liver transplants were performed (median age 59 years, 77% male). In the DAA era (2014-2017) there has been a 14.6% decrease in LT for HCV-related HCC; however, HCV remains the most common etiology in 50% of cases. In the same era, there has been a 50% increase in LT for NAFLD-related HCC. Overall survival was significantly worse for HCV-related HCC compared to NAFLD-related HCC during pre-DAA era (2002-2013; P = .031), but these differences disappeared in the DAA era. In addition, HCV patients had a significant improvement in survival when comparing the DAA era with IFN era (P < .001). Independent predictors of survival were significantly different in the pre-DAA era (HCV, AFP, diabetes) than in the DAA era (tumor size). HCV-related HCC continues to be the main indication for LT in the DAA era, but patients' survival has significantly improved and is comparable to that of NAFLD-related HCC.