Clin Mol Hepatol.  2014 Jun;20(2):192-203. 10.3350/cmh.2014.20.2.192.

Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation

• Lee JY
• Kim YH
• Yi NJ
• Kim HS
• Lee HS
• Lee BK
• Kim H
• Choi YR
• Hong G
• Lee KW
• Suh KS

• KMID: 1788569
• DOI: http://doi.org/10.3350/cmh.2014.20.2.192

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.

Keyword

Immunosuppression; Basiliximab; Microvascular invasion; PIVKA-II; AFP; 18F-PET scan

MeSH Terms

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
Biological Markers
Immunosuppressive Agents
Protein Precursors
Prothrombin
alpha-Fetoproteins