Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation.
10.3350/cmh.2014.20.2.192
- Author:
Ju Yeun LEE
1
;
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
Author Information
1. Department of Pharmacy, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Immunosuppression;
Basiliximab;
Microvascular invasion;
PIVKA-II;
AFP;
18F-PET scan
- MeSH:
Adult;
Aged;
Biological Markers/analysis;
Carcinoma, Hepatocellular/mortality/pathology/*therapy;
Female;
Humans;
Immunosuppressive Agents/*therapeutic use;
Liver Neoplasms/mortality/pathology/*therapy;
*Liver Transplantation;
Male;
Middle Aged;
Neoplasm Recurrence, Local;
Positron-Emission Tomography;
Protein Precursors/analysis;
Prothrombin/analysis;
Regression Analysis;
Risk Factors;
Severity of Illness Index;
Survival Rate;
alpha-Fetoproteins/analysis
- From:Clinical and Molecular Hepatology
2014;20(2):192-203
- CountryRepublic of Korea
- Language:English
-
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.
