The risk of de novo hepatocellular carcinoma still exists in the in the direct acting antiviral era

Hepatitis C (HCV) has contributed substantially to the near doubling of hepatocellular carcinoma (HCC) incidence over the last 20 years. HCC represents the most common primary hepatic malignancy the 5th most common malignancy worldwide and the 2nd leading cause of cancer related death (1). HCC is the leading cause of death among patients with cirrhosis. HCC has the fastest growing death rate of any cancer in the United States (1). Currently, HCV is the leading indication for liver transplantation (LT) in the United States (2), without treatment HCV recurrence in the transplant allograft is nearly universal.