Results of 15-Year Experience in Liver Transplant for Hepatocellular Carcinoma.

BACKGROUND: Liver transplant (LT) supposes a curative option for those patients with hepatocellular carcinoma (HCC) meeting the Milan criteria. Adjuvant therapies, such as transarterial chemoembolization (TACE), can prevent tumor progression. Our aim was to analyze the outcomes of patients who have been transplanted at our center and to assess the effectiveness of TACE in patients on the waiting list for LT. METHODS: Eighty-nine patients who underwent LT for HCC at our hospital from 2002 to 2017 were included. Data on the number and size of nodules on image testing and explant, frequency of TACE and tumor response, mortality, and tumor recurrence were collected. TACE was indicated when waiting time was estimated to exceed 6 months in patients with well-preserved liver function (Child-Pugh score A-B7). Magnetic resonance imaging (MRI) was performed after TACE. RESULTS: We found a single nodule in 64% of patients and multiple nodules in 36% of patients. Mean size of nodule on image testing was 38.29 mm, similar to the mean size at explant (32.65 mm). TACE was performed in 66 patients (74.2%). Ten patients did not meet the Milan criteria at explant, 6 of whom died, and 10 patients had tumor recurrence at mean of 22.6 months. Overall mortality was 44.9%, but only 10 patients died because of tumor recurrence. CONCLUSIONS: TACE responses were achieved in one third of patients and there was an 11.2% recurrence rate for HCC. Mortality in our experience has been related to exceeding the Milan criteria at explant.

Therapy With Direct-Acting Antiviral Agents for Hepatitis C in Liver Transplant Recipients.

BACKGROUND: Recurrent infection with the hepatitis C virus (HCV) after liver transplantation (LT) is associated with decreased graft and patient survival. Direct-acting antiviral (DAA) therapies have changed the landscape of HCV due to their excellent safety profile and cure rates. Our aim was to evaluate the efficacy and tolerability of antiviral therapy in recurrent HCV after LT with DAA therapy. METHODS: Our retrospective analysis included 46 LT recipients with HCV recurrence. Patients received therapy with DAA therapy between November 2014 and May 2016. Stage of fibrosis was documented by transient elastography (FibroScan). RESULTS: Thirty-three of the patients were men (71.7%), with a mean age of 59.6 years. Most patients were infected with HCV genotype 1 (71.7%) (1a = 7, 1b = 26) or genotype 3 (19.6%). Cirrhosis was present in 10 (21.7%). The most frequent immunosuppression regimen was tacrolimus + mycophenolate mofetil (MMF) (41.3%). Most patients received sofosbuvir + simeprevir (SOF+SMV) (n = 13, 28.3%) and sofosbuvir + daclatasvir (SOF+DCV) (n = 15, 32.6%). A virologic response at posttreatment week 12 was detected in 93.8% of the patients. Two patients failed treatment (1 had resistance-associated variants [RAVs] Y93H in NS5A). Three patients died due to chronic rejection, acute arterial thrombosis, and spontaneous bacterial peritonitis. Adverse events were observed in 23 patients (50%). The most common events were asthenia in 17 (37%) and headache in 6 (13%) patients. One patient discontinued treatment due to serious adverse events attributable to the drug's interaction with tacrolimus. CONCLUSIONS: DAAs are safe and effective for use in treating HCV recurrence after LT, with results similar to those seen in the general population, including patients with cirrhosis.