Gut Liver.  2016 Jul;10(4):604-610. 10.5009/gnl15017.

Efficacy and Safety of a Steroid-Free Immunosuppressive Regimen after Liver Transplantation for Hepatocellular Carcinoma

• Wei Q
• Xu X
• Wang C
• Zhuang R
• Zhuang L
• Zhou L
• Xie H
• Wu J
• Zhang M
• Shen Y
• Wang W
• Zheng S

• KMID: 2412050
• DOI: http://doi.org/10.5009/gnl15017

Abstract

BACKGROUND/AIMS
We aimed to evaluate the efficacy and safety of an immunosuppressive regimen without steroids after liver transplantation (LT) for hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC).
METHODS
Sixty-six HCC patients who underwent an immunosuppressive regimen without steroids after LT were enrolled in the steroid-free group. The preoperative characteristics and postoperative outcomes of these patients were compared with those of 132 HCC recipients who were placed on an immunosuppressive regimen using steroids (steroid group). The incidence of acute rejection, HBV recurrence, infection, and new-onset diabetes mellitus and the overall and tumor-free survival rates were compared between the two groups.
RESULTS
Differences were not observed in the 1-year (83.3% vs 97.0%, p=0.067), 3-year (65.4% vs 75.8%, p=0.067) or 5-year (56.3% vs 70.7%, p=0.067) patient survival rates or in the 1-year (62.1% vs 72.7%, p=0.067), 3-year (49.8% vs 63.6%, p=0.067) or 5-year (48.6% vs 63.6%, p=0.067) tumor-free survival rates between the two groups, respectively. In the steroid-free group, the patients who fulfilled the Milan criteria had higher overall and tumor-free survival rates than those in the steroid group (p<0.001). The prevalence of HBV recurrence (3.0% vs 13.6%, p=0.02) was significantly lower in the steroid-free group compared with the steroid group.
CONCLUSIONS
After LT, an immunosuppressive regimen without steroids could be a safe and feasible treatment for HBV-related HCC patients, thus resulting in the reduction of HBV recurrence. Based on the observed survival rates, patients who fulfill the Milan criteria may derive benefits from steroid-free immunosuppression.

Keyword

Carcinoma, hepatocellular; Immunosuppression; Liver transplantation; Steroids; Survive

MeSH Terms

Antibodies, Monoclonal/administration & dosage
Carcinoma, Hepatocellular/surgery/virology
Drug Administration Schedule
Drug Therapy, Combination
Female
Glucocorticoids/*administration & dosage
Hepatitis B/complications/virology
Hepatitis B virus
Humans
Immunosuppression/*methods
Immunosuppressive Agents/*administration & dosage
Liver Neoplasms/surgery/virology
*Liver Transplantation
Male
Methylprednisolone/administration & dosage
Middle Aged
Mycophenolic Acid/administration & dosage
Postoperative Period
Prednisolone/administration & dosage
Recombinant Fusion Proteins/administration & dosage
Tacrolimus/administration & dosage
Treatment Outcome
Antibodies, Monoclonal
Glucocorticoids
Immunosuppressive Agents
Recombinant Fusion Proteins
Prednisolone
Mycophenolic Acid
Tacrolimus
Methylprednisolone