Additional Supporting Information may be found in the online version of this article. “
“Liver transplantation is an
important treatment option for selected patients with nonresectable hepatocellular carcinoma (HCC). Several reports have suggested a lower risk of posttransplant tumor recurrence with the use of sirolimus and a higher one with calcineurin inhibitors, but the selection of an ideal immunosuppression protocol is still a matter of debate. The aim of this study was to define the immunosuppression associated with the best survival after liver Silmitasertib transplantation for HCC. It was based on the Scientific Registry of Transplant Recipients and included 2,491 adult recipients of isolated liver transplantation for HCC Volasertib mouse and 12,167 for non-HCC diagnoses between March 2002 and March 2009.
All patients remained on stable maintenance immunosuppression protocols for at least 6 months posttransplant. In a multivariate analysis, only anti-CD25 antibody induction and sirolimus-based maintenance therapy were associated with improved survivals after transplantation for HCC (hazard ratio [HR] 0.64, 95% confidence interval [CI]: 0.45–0.9, P ≤ 0.01; HR 0.53, 95% CI: 0.31–0.92, P ≤ 0.05, respectively). The other studied drugs, including calcineurin inhibitors, did not demonstrate a significant impact. In an effort to understand whether the observed effects were due to a direct impact of the drug
on tumor or more on liver transplant in general, we conducted a similar analysis on non-HCC patients. Although anti-CD25 induction was again associated with a trend toward improved survival, sirolimus showed a trend toward lower rates of survival Phosphatidylinositol diacylglycerol-lyase in non-HCC recipients, confirming the specificity of its beneficial impact to cancer patients. Conclusion: According to these data, sirolimus-based immunosuppression has unique posttransplant effects on HCC patients that lead to improved survival. (HEPATOLOGY 2010.) Liver transplantation is the treatment of choice for selected patients with nonresectable hepatocellular carcinoma (HCC). Although the surgical procedure is well established, the definition of the most appropriate immunosuppression combination, allowing decreased risk of tumor recurrence and improved survival, is still a matter of debate. To date, no single protocol has gained broad acceptance. In recent years this lack of consensus has become more acute, given the increasing number of patients undergoing transplantation for HCC, currently the second commonest indication for liver transplantation in the USA, after hepatitis C virus (HCV) disease (www.ustransplant.org/annual_reports). We can also expect the number of transplantation for HCC to further increase, with several recent studies showing that selected patients beyond Milan criteria can be safely considered for transplantation.