Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation
Clinical and Molecular Hepatology
;
: 192-203, 2014.
Article
Dans Anglais
| WPRIM
| ID: wpr-119484
ABSTRACT
BACKGROUND/AIMS:
The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate 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 were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to 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, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (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, and positive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).CONCLUSIONS:
Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.
Texte intégral:
Disponible
Indice:
WPRIM (Pacifique occidental)
Sujet Principal:
Précurseurs de protéines
/
Indice de gravité de la maladie
/
Prothrombine
/
Marqueurs biologiques
/
Alphafoetoprotéines
/
Taux de survie
/
Analyse de régression
/
Facteurs de risque
/
Transplantation hépatique
/
Carcinome hépatocellulaire
Type d'étude:
Etude diagnostique
/
Etude d'étiologie
/
Facteurs de risque
Limites du sujet:
Adulte
/
Adulte très âgé
/
Femelle
/
Humains
/
Mâle
langue:
Anglais
Texte intégral:
Clinical and Molecular Hepatology
Année:
2014
Type:
Article
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