Ann Hepatobiliary Pancreat Surg.  2017 Nov;21(4):205-211. 10.14701/ahbps.2017.21.4.205.

Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria: re-inventing the role of mammalian target of rapamycin inhibitors

• Thorat A
• Jeng LB
• Yang HR
• Yeh CC
• Hsu SC
• Chen TH
• Poon KS

• KMID: 2397800
• DOI: http://doi.org/10.14701/ahbps.2017.21.4.205

Abstract

BACKGROUNDS/AIMS
The protective effect of everolimus (EVR) in hepatocellular carcinoma (HCC) patients who receive liver transplantation in terms of reducing the recurrence has not been sufficiently investigated in clinical trials. In this second stage of our ongoing study, we intend to analyze the effects of EVR as an immunosuppressant, when it is started in the early phase after living donor liver transplantation (LDLT), on HCC recurrence in patients with HCC within the University of California at San Francisco (UCSF) criteria.
METHODS
From January 2011 to June 2013, a total of 250 patients underwent LDLT for HCC at our institute. The patients with HCC within the UCSF criteria were included in the study and divided in two groups depending upon the postoperative immunosuppression. Group A: HCC patients that received EVR+TAC based immunosuppressive regimen (n=37). Group B: HCC patients that received standard TAC based immunosuppressive regimen without EVR (n=29). The target trough level for EVR was 3 to 5 ng/ml while for TAC it was 8-10 ng/ml.
RESULTS
For group A patients, the mean trough level of the EVR was 3.47±1.53 ng/ml (range, 1.5-11.2) with a daily dose of 1.00±0.25 mg/day. For group A and B, the average TAC trough levels were 6.97±3.98 ng/ml (range, 2.50 to 11.28 ng/ml) and 6.93±2.58 (range, 2-16.30), respectively. The 1-year, 3-year and 4-year overall survival achieved for Group A patients was 94.95%, 86.48% and 86.48%, respectively while for Group B patients it was 82.75%, 68.96%, and 62.06%, respectively (p=0.0217).
CONCLUSIONS
EVR use in liver transplant recipients in the early stage after transplantation reduces the HCC recurrence rates in HCC patients within the UCSF criteria.

Keyword

Everolimus; Living donor liver transplantation; Hepatocellular carcinoma; Hepatic artery thrombosis

MeSH Terms

California
Carcinoma, Hepatocellular*
Everolimus*
Humans
Immunosuppression
Liver Transplantation*
Liver*
Living Donors*
Recurrence*
Sirolimus*
Transplant Recipients
Everolimus
Sirolimus

Figure

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  Fig. 1 Overall survival of the HCC patients with and without EVR after LDLT.

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