Korean J Hepatobiliary Pancreat Surg.  2014 May;18(2):48-51. 10.14701/kjhbps.2014.18.2.48.

Tailored long-term immunosuppressive regimen for adult liver transplant recipients with hepatocellular carcinoma

• Kang SH
• Hwang S
• Ha TY
• Song GW
• Jung DH
• Kim KH
• Ahn CS
• Moon DB
• Park GC
• Jung BH
• Yoon YI
• Lee SG

• KMID: 2305242
• DOI: http://doi.org/10.14701/kjhbps.2014.18.2.48

Abstract

BACKGROUNDS/AIMS
There are few guidelines for tailored immunosuppressive regimens for liver transplantation (LT) recipients with hepatocellular carcinoma (HCC). To establish long-term immunosuppressive regimens suitable for Korean adult LT recipients, we analyzed those that were currently in use at a single high-volume institution.
METHODS
This cross-sectional study comprises three parts including review of the immunosuppressive regimens used to manage 2,147 adult LT outpatients, review of LT recipients who were diagnosed of HCC at LT, and review of LT recipients who suffered from HCC recurrence.
RESULTS
In 1,000 adult LT recipients who were living more than 5 years with no adverse events, 916 received a calcineurin inhibitor (CNI)-based therapy (CNI only in 520; CNI with mycophenolate mofetil [MMF] in 396) and 84 were receiving an MMF-based therapy (MMF only in 45; MMF with minimal CNI in 39). Tacrolimus was preferred over cyclosporine for both monotherapy and combination therapy along the passage of posttransplant period. There was no difference in selection of immunosuppressants, target blood concentration, and rate of combination therapy between LT recipients with and without HCC, except for the first 1 year. Sirolimus-based regimens were applied in 21 patients who showed HCC recurrence. Sorafenib was often used after conversion to sirolimus.
CONCLUSIONS
Tailored immunosuppressive regimen covering the long-term posttransplant period should be established after consideration of individualized patient profiles including HCC.

Keyword

Immunosuppressive regimen; Liver transplantation; Hepatocellular carcinoma; Calcineurin inhibitor; Sirolimus

MeSH Terms

Adult*
Calcineurin
Carcinoma, Hepatocellular*
Cross-Sectional Studies
Cyclosporine
Humans
Immunosuppressive Agents
Liver Transplantation
Liver*
Outpatients
Recurrence
Sirolimus
Tacrolimus
Transplantation*
Calcineurin
Cyclosporine
Immunosuppressive Agents
Sirolimus
Tacrolimus

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