Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation
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Background/Aims: The most commonly used immunosuppressant therapy after liver transplantation (LT) is acombination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the mostappropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated. Methods: Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants wereincluded. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was addedto reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ± 1.3 ng/mL (mean ± SD). Results: The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulativesteroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alphafetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels,and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, andpositive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-yearrecurrence (P<0.05). Conclusions: Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact withrespect to early HCC recurrence (i.e., within 1 year) in high-risk patients.
Abstract
Background/Aims: The most commonly used immunosuppressant therapy after liver transplantation (LT) is acombination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the mostappropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated. Methods: Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants wereincluded. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was addedto reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ± 1.3 ng/mL (mean ± SD). Results: The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulativesteroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alphafetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels,and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, andpositive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-yearrecurrence (P<0.05). Conclusions: Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact withrespect to early HCC recurrence (i.e., within 1 year) in high-risk patients.
참고문헌 (36)
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