The Risk of Hepatocellular Carcinoma After Directly Acting Antivirals for Hepatitis C Virus Treatment in Liver Transplanted Patients: Is It Real?

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, extrahepatic HCC in a livertransplanted patient soon after successful treatment with DAAs, along with a short review of literature.Case PresentationIn 2010, a 53year 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 pegylatedIFN 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, alphafetoprotein was 2.9 ng/mL before DAAs, increasing up to 183.1 ng/mL at week24 of followup after the completion of therapy. Therefore, CT scan of abdomen was performed again, showing two splenic HCC lesions.ConclusionsOverall, 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 followup should be performed after DAA treatment.