Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation
Ju-Yeun LEE; Yul-Hee KIM; Nam-Joon YI; Hyang-Sook KIM; Hye-Suk LEE; Byung-Koo LEE; Hyeyoung KIM; Young-Rok CHOI; Geun HONG; Kwang-Woong LEE; Kyung-Suk SUH.
Clinical and Molecular Hepatology
; : 192-203, 2014.
Artículo
en Inglés
| WPRIM | ID: wpr-119484
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.
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