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dc.contributor.authorMuna-Aguon, Paul
dc.contributor.authorRamanathan, Meera
dc.contributor.authorChoi, Myunghan
dc.contributor.authorPedersen, Mark
dc.contributor.authorSeetharam, Anil
dc.date.accessioned2019-12-06T18:41:48Z
dc.date.available2019-12-06T18:41:48Z
dc.date.issued2019
dc.identifier.citationMuna-Aguon, P., Ramanathan, M., Choi, M., Pedersen, M., & Seetharam, A. Lymphovascular invasion on explant is associated with presenting tumor characteristics and not direct acting antiviral utilization in hepatitis C candidates undergoing liver transplantation. Clinical and Experimental Hepatology, 5(1).en_US
dc.identifier.issn2392-1099
dc.identifier.doi10.5114/ceh.2019.88105
dc.identifier.urihttp://hdl.handle.net/10150/636313
dc.description.abstractAim of the study: Utilization of direct acting antiviral (DAA) therapy in candidates with well-compensated hepatitis C virus (HCV) cirrhosis and hepatocellular carcinoma (HCC) accruing end stage liver disease (MELD) exception points is highly variable among transplant centers based on center location, local organ procurement dynamics, HCV(+) organ availability, and patient preference. The association between DAA utilization prior to transplant and incidence of lymphovascular invasion on explant is unknown. Material and methods: Retrospective evaluation from 2013-2017 of patients on a liver transplant (LT) waitlist with HCV-related cirrhosis, MELD-Na < 15, and HCC (within T2/Milan criteria). The cohort was divided into the pre-LT DAA treated group and untreated group with clinical/viral demographics collected. Tumor presenting characteristics, locoregional treatments, wait time to LT, dropout rates and explant pathology were compared. Results: DAAs were used in 44 patients prior to LT (SVR12 of 37/44 [84%]) and 19 left untreated with LT performed in 81% (51/63) of the waitlisted cohort. No significant differences were found between groups with regards to clinical/viral demographics, local-regional therapy (LRT) sessions, or frequency of lymphovascular invasion on explant. The untreated cohort had a higher rate of dropout (6.3% vs. 3.2%) (p = 0.041). On subgroup analysis of 51 subjects undergoing LT, AFP > 250 ng/ml (p = 0.003) and multifocal HCC (> 1 lesion) (p = 0.006) were associated with lymphovascular invasion on explant while DAA therapy was not (p = 0.578). Conclusions: DAA therapy for waitlist active HCV candidates accruing MELD exception points has no deleterious effects on bridging LRT, nor is it associated with increased frequency of lymphovascular invasion on explant. The latter appears driven by tumor related characteristics (AFP and number of lesions) irrespective of DAA utilization prior to LT.en_US
dc.language.isoenen_US
dc.publisherTERMEDIA PUBLISHING HOUSE LTDen_US
dc.rights© 2019 Clinical and Experimental Hepatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/).en_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc-sa/4.0/
dc.subjectliver transplantationen_US
dc.subjecthepatocellular carcinomaen_US
dc.subjectlymphovascular invasionen_US
dc.subjecthepatitis C virus infectionen_US
dc.titleLymphovascular invasion on explant is associated with presenting tumor characteristics and not direct acting antiviral utilization in hepatitis C candidates undergoing liver transplantationen_US
dc.typeArticleen_US
dc.identifier.eissn2449-8238
dc.contributor.departmentUniv Arizona, Coll Med Phoenixen_US
dc.identifier.journalCLINICAL AND EXPERIMENTAL HEPATOLOGYen_US
dc.description.noteOpen access journalen_US
dc.description.collectioninformationThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at repository@u.library.arizona.edu.en_US
dc.eprint.versionFinal published versionen_US
dc.source.volume5
dc.source.issue4
dc.source.beginpage279-284
refterms.dateFOA2019-12-06T18:41:49Z


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© 2019 Clinical and Experimental Hepatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/).
Except where otherwise noted, this item's license is described as © 2019 Clinical and Experimental Hepatology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (http://creativecommons.org/licenses/by-nc-sa/4.0/).