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Strazzulla A, Maria Rita Iemmolo R, Carbone E, Concetta Postorino M, Mazzitelli M, De Santis M, Di Benedetto F, Maria Cristiani C, Costa C, Pisani V, Torti C. The Risk of Hepatocellular Carcinoma After Directly Acting Antivirals for Hepatitis C Virus Treatment in Liver Transplanted Patients: Is It Real? Hepat Mon 2016; 16:e41933. [PMID: 28070200 PMCID: PMC5203700 DOI: 10.5812/hepatmon.41933] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Since directly acting antivirals (DAAs) for treatment of hepatitis C virus (HCV) were introduced, conflicting data emerged about the risk of hepatocellular carcinoma (HCC) after interferon (IFN)-free treatments. We present a case of recurrent, extra-hepatic HCC in a liver-transplanted patient soon after successful treatment with DAAs, along with a short review of literature. CASE PRESENTATION In 2010, a 53-year old man, affected by chronic HCV (genotype 1) infection and decompensated cirrhosis, underwent liver resection for HCC and subsequently received orthotopic liver transplantation. Then, HCV relapsed and, in 2013, he was treated with pegylated-IFN plus ribavirin; but response was null. In 2014, he was treated with daclatasvir plus simeprevir to reach sustained virological response. At baseline and at the end of HCV treatment, computed tomography (CT) scan of abdomen excluded any lesions suspected for HCC. However, alpha-fetoprotein was 2.9 ng/mL before DAAs, increasing up to 183.1 ng/mL at week-24 of follow-up after the completion of therapy. Therefore, CT scan of abdomen was performed again, showing two splenic HCC lesions. CONCLUSIONS Overall, nine studies have been published about the risk of HCC after DAAs. Patients with previous HCC should be carefully investigated to confirm complete HCC remission before starting, and proactive follow-up should be performed after DAA treatment.
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Affiliation(s)
- Alessio Strazzulla
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Rosa Maria Rita Iemmolo
- Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Ennio Carbone
- Experimental and Clinic Medicine, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Concetta Postorino
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Maria Mazzitelli
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Mario De Santis
- Unit of Radiology, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabrizio Di Benedetto
- Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Costanza Maria Cristiani
- Experimental and Clinic Medicine, Department of Experimental and Clinical Medicine, “Magna Graecia” University, Catanzaro, Italy
| | - Chiara Costa
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Vincenzo Pisani
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
| | - Carlo Torti
- Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, “Magna Graecia” University, Catanzaro, Italy
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