title: The Risk of Hepatocellular Carcinoma After Directly Acting Antivirals for Hepatitis C Virus Treatment in Liver Transplanted Patients: Is It Real?
abstract: 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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Alessio
authors.initials: A
authors.lastname: Strazzulla
authors.affiliation: Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Rosa Maria Rita
authors.initials: RMR
authors.lastname: Iemmolo
authors.affiliation: 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.
authors.forename: Ennio
authors.initials: E
authors.lastname: Carbone
authors.affiliation: Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Maria Concetta
authors.initials: MC
authors.lastname: Postorino
authors.affiliation: Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Maria
authors.initials: M
authors.lastname: Mazzitelli
authors.affiliation: Unit of Radiology, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: De Santis
authors.affiliation: Liver and Multivisceral Transplant Center, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Di Benedetto
authors.affiliation: Experimental and Clinic Medicine, Department of Experimental and Clinical Medicine, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Costanza Maria
authors.initials: CM
authors.lastname: Cristiani
authors.affiliation: Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Costa
authors.affiliation: Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pisani
authors.affiliation: Unit of Infectious and Tropical Diseases, Department of Medical and Surgical Sciences, "Magna Graecia" University, Catanzaro, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Torti
keywords: Directly Acting Antivirals; Hepatitis C Virus; Hepatocellular Carcinoma; Interferon; Liver Transplant