In this meta-analysis of individual patient data, impacts of direct-acting antiviral (DAA) exposure on hepatocellular carcinoma (HCC) recurrence risk are inconclusive. Active clinical as well as radiological follow-up of patients with HCC after HCV eradication with DAA is valid.

• From 21 studies of HCV-related cirrhosis and HCC, data were pooled from 977 consecutive patients who achieved complete radiological response following surgical/locoregional treatments and took DAAs (DAA group); propensity score-matched patients from the ITA.LI.CA. cohort (n=328) were DAA-unexposed controls (no-DAA group).

• In DAA-treated patients, recurrence rate and death risk per 100 person-years were reported to be 20 (95% CI 13.9 to 29.8) and 5.7 (2.5 to 15.3), respectively.

• Alpha-fetoprotein logarithm, HCC recurrence history pre-DAA initiation, performance status and tumor burden pre-HCC treatment were identified to be predictive factors for recurrence.

• Relative risk did not differ significantly between the DAA-exposed and DAA-unexposed groups in propensity score-matched patients (relative risk=0.64, 95% CI 0.37 to 1.1).