eISSN: 2449-8238
ISSN: 2392-1099
Clinical and Experimental Hepatology
Current issue Archive Manuscripts accepted About the journal Editorial board Abstracting and indexing Subscription Contact Instructions for authors Ethical standards and procedures
Editorial System
Submit your Manuscript
SCImago Journal & Country Rank
4/2019
vol. 5
 
Share:
Share:
abstract:
Original paper

Lymphovascular invasion on explant is associated with presenting tumor characteristics and not direct acting antiviral utilization in hepatitis C candidates undergoing liver transplantation

Paul Muna-Aguon
1
,
Meera Ramanathan
1
,
Myunghan Choi
2
,
Mark Pedersen
3
,
Anil Seetharam
4, 5

1.
Internal Medicine, Banner University Medical Center, Phoenix, AZ, United States
2.
Arizona State School of Nursing and Innovation, Tempe, AZ, United States
3.
Division of Digestive and Liver Diseases, University of Texas Southwestern, Dallas, TX, United States
4.
Banner Transplant and Advanced Liver Disease Center, Phoenix, AZ, United States
5.
University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States
Clin Exp HEPATOL 2019; 5, 4: 279–284
Online publish date: 2019/09/20
View full text Get citation
 
PlumX metrics:
Aim of the study
Utilization of direct acting antiviral (DAA) therapy in candidates with well-compensated hepatitis C virus (HCV) cirrhosis and hepatocellular carcinoma (HCC) accruing end stage liver disease (MELD) exception points is highly variable among transplant centers based on center location, local organ procurement dynamics, HCV(+) organ availability, and patient preference. The association between DAA utilization prior to transplant and incidence of lymphovascular invasion on explant is unknown.

Material and methods
Retrospective evaluation from 2013-2017 of patients on a liver transplant (LT) waitlist with HCV-related cirrhosis, MELD-Na < 15, and HCC (within T2/Milan criteria). The cohort was divided into the pre-LT DAA treated group and untreated group with clinical/viral demographics collected. Tumor presenting characteristics, locoregional treatments, wait time to LT, dropout rates and explant pathology were compared.

Results
DAAs were used in 44 patients prior to LT (SVR12 of 37/44 [84%]) and 19 left untreated with LT performed in 81% (51/63) of the waitlisted cohort. No significant differences were found between groups with regards to clinical/viral demographics, local-regional therapy (LRT) sessions, or frequency of lymphovascular invasion on explant. The untreated cohort had a higher rate of dropout (6.3% vs. 3.2%) (p = 0.041). On subgroup analysis of 51 subjects undergoing LT, AFP > 250 ng/ml (p = 0.003) and multifocal HCC (> 1 lesion) (p = 0.006) were associated with lymphovascular invasion on explant while DAA therapy was not (p = 0.578).

Conclusions
DAA therapy for waitlist active HCV candidates accruing MELD exception points has no deleterious effects on bridging LRT, nor is it associated with increased frequency of lymphovascular invasion on explant. The latter appears driven by tumor related characteristics (AFP and number of lesions) irrespective of DAA utilization prior to LT.

keywords:

liver transplantation, hepatocellular carcinoma, lymphovascular invasion, hepatitis C virus infection

Quick links
© 2024 Termedia Sp. z o.o.
Developed by Bentus.