1 Liver Cancer Program, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, New York.
2 Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, New York.
3 Icahn School of Medicine at Mount Sinai, Division of Liver Diseases, New York, New York.
4 Icahn School of Medicine at Mount Sinai, Recanati / Miller Transplantation Institute, New York, New York.
5 Johns Hopkins University School of Medicine, Division of Gastroenterology and Hepatology-Transplant Hepatology, Baltimore, Maryland.
6 Liver Cancer Translational Lab, Barcelona Clinic Liver Cancer (BCLC) Group, Liver Unit, Hospital Clinic de Barcelona, IDIBAPS, CIBEREHD, University of Barcelona, Barcelona, Catalonia, Spain.
7 Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain.
HCV 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 LT 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=0.031), but these differences disappeared in the DDA era. In addition, HCV patients had a significant improvement in survival when comparing DAA-era with IFN-era (p<0.001). 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.