Reduced exposure to calcineurin inhibitors early after liver transplantation prevents recurrence of hepatocellular carcinoma
| Autor: | Antonio Poyato-González, José Luis Montero-Álvarez, G. Pieri, Emmanuel Tsochatzis, James O'Beirne, Gustavo Ferrín-Sánchez, María Carmen Naveas, Javier Briceño, Manuel Rodríguez-Perálvarez, Carmen García-Caparrós, Douglas Thorburn, David Patch, Andrew K. Burroughs, Manuel de la Mata |
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| Rok vydání: | 2013 |
| Předmět: |
Male
medicine.medical_specialty Carcinoma Hepatocellular medicine.medical_treatment Calcineurin Inhibitors Liver transplantation Milan criteria Gastroenterology Internal medicine medicine Humans Aged Proportional Hazards Models Retrospective Studies Hepatology Proportional hazards model business.industry TOR Serine-Threonine Kinases Liver Neoplasms Immunosuppression Middle Aged medicine.disease digestive system diseases Tacrolimus Surgery Liver Transplantation Calcineurin Regimen Hepatocellular carcinoma Female Neoplasm Recurrence Local business Immunosuppressive Agents |
| Zdroj: | Journal of hepatology. 59(6) |
| ISSN: | 1600-0641 |
| Popis: | Background & Aims Recurrence of hepatocellular carcinoma (HCC) is a major complication after liver transplantation (LT). The initial immunosuppression protocol may influence HCC recurrence, but the optimal regimen is still unknown. Methods 219 HCC consecutive patients under Milan criteria, who received an LT at 2 European centres between 2000 and 2010, were included. Median follow-up was 51months (IQR 26-93). Demographic characteristics, HCC features, and immunosuppression protocol within the first month after LT were evaluated against HCC recurrence by using Cox regression. Results In the explanted liver, 110 patients (50%) had multinodular HCC, and largest nodule diameter was 3±2.1cm. Macrovascular invasion was incidentally detected in 11 patients (5%), and microvascular invasion was present in 41 patients (18.7%). HCC recurrence rates were 13.3% at 3years and 17.6% at 5years. HCC recurrence was not influenced by the use/non-use of steroids and antimetabolites ( p =0.69 and p =0.70 respectively), and was similar with tacrolimus or cyclosporine ( p =0.25). Higher exposure to calcineurin inhibitors within the first month after LT (mean tacrolimus trough concentrations >10ng/ml or cyclosporine trough concentrations >300ng/ml), but not thereafter, was associated with increased risk of HCC recurrence (27.7% vs. 14.7% at 5years; p =0.007). The independent predictors of HCC recurrence by multivariate analysis were: high exposure to calcineurin inhibitors defined as above (RR=2.82; p =0.005), diameter of the largest nodule (RR=1.31; p p =0.003) and macrovascular invasion (RR=4.57; p =0.003). Conclusions Immunosuppression protocols with early CNI minimization should be preferred in LT patients with HCC in order to minimize tumour recurrence. |
| Databáze: | OpenAIRE |
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