Meta‐analysis: recurrence and survival following the use of sirolimus in liver transplantation for hepatocellular carcinoma

Summary Background The use of sirolimus (SRL)‐based immunosuppression protocols have been reported to reduce recurrence rates following liver transplantation (LT) for hepatocellular carcinoma (HCC), although this is still a matter for debate. Aim To undertake a systematic review and meta‐analysis of...

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Bibliographic Details
Published in:Alimentary pharmacology & therapeutics 2013-02, Vol.37 (4), p.411-419
Main Authors: Menon, K. V., Hakeem, A. R., Heaton, N. D.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Carcinoma, Hepatocellular - diagnosis
Carcinoma, Hepatocellular - surgery
Digestive system
Gastroenterology. Liver. Pancreas. Abdomen
Graft Survival - drug effects
Humans
Immunosuppressive Agents - adverse effects
Immunosuppressive Agents - therapeutic use
Liver Neoplasms - diagnosis
Liver Neoplasms - surgery
Liver Transplantation
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Neoplasm Recurrence, Local - prevention & control
Pharmacology. Drug treatments
Sirolimus - adverse effects
Sirolimus - therapeutic use
Survival Rate
Tumors
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Summary:Summary Background The use of sirolimus (SRL)‐based immunosuppression protocols have been reported to reduce recurrence rates following liver transplantation (LT) for hepatocellular carcinoma (HCC), although this is still a matter for debate. Aim To undertake a systematic review and meta‐analysis of available literature on the usage of SRL as an immunosuppressive agent following LT for HCC, with a view to comparing cancer outcomes with the commonly used calcineurin inhibitors (CNIs). Methods Systematic review and meta‐analysis carried out in line with the Meta‐analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Primary outcomes of interest were tumour recurrence rate and recurrence‐free survival (RFS). Secondary outcomes were recurrence‐related mortality and overall survival (OS). Results In all, 5 studies met the inclusion criteria (n = 474). The recurrence rate was lower in SRL group (4.9–12.9%) in comparison with CNIs (17.3–38.7%). The 1‐, 3‐ and 5‐year RFS was 93–96%, 82–86% and 79–80% for SRL group, which was much better in comparison with the CNIs 70–78%, 64–65% and 54–60% respectively. Similarly, 1‐, 3‐ and 5‐year OS was much better for SRL group (94–95%, 85% and 80%) in comparison with CNIs (79–83%, 66% and 59–62%) respectively. Meta‐analysis demonstrated lower recurrence (OR = 0.30, 95% CI = 0.16–0.55, P 
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.12185