SNFGE SNFGE
 
Thématique :
- Foie
Originalité :
Intermédiaire
Solidité :
Très solide
Doit faire évoluer notre pratique :
Dans certains cas
 
 
Nom du veilleur :
Professeur Christine SILVAIN
Coup de coeur :
 
 
Hepatology
  2018/10  
 
  2018 Oct;68(4):1288-1297.  
  doi: 10.1002/hep.30045.  
 
  De Novo Hepatocellular Carcinoma Among Liver Transplant Registrants in the Direct Acting Antiviral Era.  
 
  Kwong AJ, Kim WR, Flemming JA  
  https://www.ncbi.nlm.nih.gov/pubmed/29672886  
 
 

Abstract

The risk of hepatocellular carcinoma (HCC) in patients with hepatitis C virus (HCV) receiving direct acting antivirals (DAAs) has been debated. This study aims to describe the incidence of HCC among patients listed for liver transplantation (LT) in the DAA era. Individuals with cirrhosis listed for LT from January 2003 to December 2015 were identified using the Scientific Registry for Transplant Recipients database. Patients with HCC at listing or HCC exception within 180 days were excluded. Patients were divided into three eras based on listing date: eras 1 (2003-2010), 2 (2011-2013), and 3 (2014-2015). Incidence rates of HCC were calculated by era and compared using incident rate ratios (IRRs). The association between HCC and listing era was evaluated using Cox regression and competing risk analyses, the latter considering death and LT as competing events. Of the 48,158 eligible wait-list registrants, 3112 (6.5%) received HCC exceptions after a median of 493 days. In 20,039 individuals with HCV, the incidence of HCC was 49% higher in era 3 versus era 1 (IRR 1.49, 95% confidence interval [CI] 1.24-1.79). In multivariate analysis, those in era 3 had a higher hazard of HCC compared with era 1 (hazard ratio 1.22, 95% CI 1.01-1.48). However, in multivariable competing risks analysis, with death and LT considered as competing events for de novo HCC, era was no longer associated with HCC (subdistribution hazard ratio 0.83, 95% CI 0.69-1.00).

CONCLUSION:

In this large population-based cohort of LT registrants, the incidence of HCC among HCV patients has increased in the DAA era. Competing risks analysis suggests that this may be explained by changes in rates of LT and wait-list mortality in the HCV population during this time. (Hepatology 2018; 00:000-000).

 

 
Question posée
 
Décrire l’incidence du CHC chez les patients sur liste de transplantation hépatique (TH) à l’aire des anti-viraux directs (AVD) à partir d’un registre en comparant 3 périodes de temps : 1 (2003-2010), 2 (2011-2013), et 3 (2014-2015).
 
Question posée
 
Chez les 20,039 patients VHC, l’incidence de CHC était 49% plus élevée dans la période 3 versus 1 (IRR 1.49, 95% , [CI] 1.24-1.79) ce qui retrouvé en analyse multivariée avec un hazard ratio de 1.22, 95% CI 1.01-1.48. En revanche, en analyse multivariée avec risques de nouveaux décès et TH estimés compétitifs, la période 3 n’est plus associée au risque de CHC.
 
Commentaires

Nécessité de modèles statistiques sophistiqués pour ne pas retenir ce sur-risque de CHC lié aux AVD.

 
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