Clin Mol Hepatol.  2021 Oct;27(4):589-602. 10.3350/cmh.2021.0038.

Impact of everolimus on survival after liver transplantation for hepatocellular carcinoma

• Kang I
• Lee JG
• Choi SH
• Kim HJ
• Han DH
• Choi GH
• Kim MS
• Choi JS
• Kim SI
• Joo DJ

• KMID: 2520842
• DOI: http://doi.org/10.3350/cmh.2021.0038

Abstract

Background/Aims
This study aimed to investigate whether everolimus (EVR) affects long-term survival after liver transplantation (LT) in patients with hepatocellular carcinoma (HCC).
Methods
The data from 303 consecutive patients with HCC who had undergone LT from January 2012 to July 2018 were retrospectively reviewed. The patients were divided into two groups: 1) patients treated with EVR in combination with calcineurin inhibitors (CNIs) (EVR group; n=114) and 2) patients treated with CNI-based therapy without EVR (non-EVR group; n=189). Time to recurrence (TTR) and overall survival (OS) after propensity score (PS) matching were compared between the groups, and prognostic factors for TTR and OS were evaluated.
Results
The EVR group exhibited more aggressive tumor biology than the non-EVR group, such as a higher number of tumors (P=0.003), a higher prevalence of microscopic vascular invasion (P=0.017) and exceeding Milan criteria (P=0.029). Compared with the PS-matched non-EVR group, the PS-matched EVR group had significantly better TTR (P<0.001) and OS (P<0.001). In multivariable analysis, EVR was identified as an independent prognostic factor for TTR (hazard ratio [HR], 0.248; P=0.001) and OS (HR, 0.145; P<0.001).
Conclusions
Combined with CNIs, EVR has the potential to prolong long-term survival in patients undergoing LT for HCC. These findings warrant further investigation in a well-designed prospective study.

Keyword

Hepatocellular carcinoma; Liver transplantation; Immunosuppression; Recurrence; Survival