Chronic HCV liver infection is considered one of the main causes of liver cirrhosis and hepatocellular carcinoma (HCC). For a selected group of patients, orthotopic liver transplantation (OLTx) is the most effective option to cure both liver diseases. After liver transplantation, patients may be at risk of viral infection reactivation and HCC recurrence. HCV recurrence on the transplanted organ can lead to graft cirrhosis and therefore the clearance of virus with antiviral therapies has a pivotal role on the prevention of graft damage. Nowadays, direct antiviral agents (DAAs) represent the choice treatment for HCV recurrence in liver transplanted patients, ensuring high eradication rates. We present the case of a liver transplant recipient who developed, 7 years after OLTx and immediately after a DAAs treatment, a subcutaneous abdominal mass with histological characteristics of HCC.
Hepatocellular carcinoma metastasis Orthotopic liver transplantation Hepatitis C infection Direct antiviral agents
This is a preview of subscription content, log in to check access.
Compliance with ethical standards
Conflict of interest
All the authors declare they have no conflict of interest.
All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.
Informed consent was obtained from all patients for being included in the study.
European Association For The Study Of The Liver. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2012;56:908–43.CrossRefGoogle Scholar
Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2017;67:358–80.CrossRefGoogle Scholar
Mazzaferro V, Llovet JM, Miceli R, et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol. 2009;10:35–43.CrossRefGoogle Scholar
Roayaie S, Blume IN, Thung SN, et al. A system of classifying microvascular invasion to predict outcome after resection in patients with hepatocellular carcinoma. Gastroenterology. 2009;137:850–5.CrossRefPubMedPubMedCentralGoogle Scholar
Kneuertz PJ, Cosgrove DP, Cameron AM, et al. Multidisciplinary management of recurrent hepatocellular carcinoma following liver transplantation. J Gastrointest Surg. 2012;16:874–81.CrossRefPubMedPubMedCentralGoogle Scholar
D’Amico F, Schwartz M, Vitale A, et al. Predicting recurrence after liver transplantation in patients with hepatocellular carcinoma exceeding the up-to-seven criteria. Liver Transpl. 2009;15:1278–87.CrossRefPubMedGoogle Scholar
Duseja A. Staging of hepatocellular carcinoma. J Clin Exp Hepatol. 2014;4(Suppl 3):74–9.CrossRefGoogle Scholar
Onen A, Sanli A, Karacam V, et al. Chest-wall metastasis in a patient who underwent liver transplantation due to hepatocellular carcinoma. Heart Lung Circ. 2008;17:156–8.CrossRefPubMedGoogle Scholar
Katyal S, Oliver JH, Peterson MS, et al. Extrahepatic metastases of hepatocellular carcinoma. Radiology. 2000;216:698–703.CrossRefGoogle Scholar
Strazzulla A, Iemolo RMR, Carbone E, et al. 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.CrossRefPubMedPubMedCentralGoogle Scholar
Reig M, Marino M, Perello C, et al. Unexpected high rate of early tumor recurrence in patients with HCV-related HCC undergoing interferon-free therapy. J Hepatol. 2016;65:719–26.CrossRefGoogle Scholar
Reig M, Boix L, Bruix J. The impact of direct antiviral agents on the development and recurrence of hepatocellular carcinoma. Liver Int. 2017;37(Suppl 1):136–9.CrossRefPubMedGoogle Scholar
Grandhe S, Frenette CT. Occurrence and recurrence of hepatocellular carcinoma after successful direct-acting antiviral therapy for patients with chronic hepatitis C virus infection. Gastroenterol Hepatol (N Y). 2017;13:421–5.Google Scholar
Cucchetti A, D’Amico G, Trevisani F, et al. Effect of direct-acting antivirals on future occurrence of hepatocellular carcinoma in compensated cirrhotic patients. Dig Liver Dis. 2018;50:156–62.CrossRefPubMedGoogle Scholar
Nagaoki Y, Aikata H, Nakano N, et al. Development of hepatocellular carcinoma in patients with hepatitis C virus infection who achieved sustained virological response following interferon therapy: a large-scale, long-term cohort study. J Gastroenterol Hepatol. 2016;31:1009–15.CrossRefPubMedGoogle Scholar
The ANRS. Lack of evidence of an effect of direct-acting antivirals on the recurrence of hepatocellular carcinoma: Data from three ANRS cohorts. J Hepatol. 2016;65:734–40.CrossRefGoogle Scholar
Yang JD, Leise MD. Damned if you do, damned if you don’t: the evolving story of de novo and recurrent hepatocellular carcinoma amongst those treated with direct-acting antivirals for hepatitis C virus. Liver Int. 2017;37:809–11.CrossRefPubMedGoogle Scholar
Yang JD, Aqel BA, Pungpapong S, et al. Direct acting antiviral therapy and tumor recurrence after liver transplantation for hepatitis C-associated hepatocellular carcinoma. J Hepatol. 2016;65:859–60.CrossRefPubMedGoogle Scholar
Reig M, Boix L, Marino Z, et al. Liver cancer emergence associated with antiviral treatment: an immune surveillance failure? Semin Liver Dis. 2017;37:109–18.CrossRefPubMedGoogle Scholar
Hengst J, Strunz B, Deterding K, et al. Nonreversible MAIT cell-dysfunction in chronic hepatitis C virus infection despite successful interferon-free therapy. Eur J Immunol. 2016;46:2204–10.CrossRefPubMedGoogle Scholar
Walker NF, Scriven J, Meintjes G, et al. Immune reconstitution inflammatory syndrome in HIV-infected patients. HIV AIDS (Auckl). 2015;7:49–64.Google Scholar
de’Angelis N, Landi F, Carra MC, et al. Managements of recurrent hepatocellular carcinoma after liver transplantation: a systematic review. World J Gastroenterol. 2015;21:11185–98.CrossRefPubMedPubMedCentralGoogle Scholar
Clavien PA, Lesurtel M, Bossuyt PM, et al. Recommendations for liver transplantation for hepatocellular carcinoma: an international consensus conference report. Lancet Oncol. 2012;13:e11–22.CrossRefPubMedGoogle Scholar