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

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. Nin...

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Bibliographic Details
Published in:Clinical and molecular hepatology 2014, 20(2), , pp.192-203
Main Authors: Lee, Ju-Yeun, Kim, Yul Hee, Yi, Nam-Joon, Kim, Hyang Sook, Lee, Hye Suk, Lee, Byung Koo, Kim, Hyeyoung, Choi, Young Rok, Hong, Geun, Lee, Kwang-Woong, Suh, Kyung-Suk
Format: Article
Language:English
Subjects:
Adult
AFP
Aged
alpha-Fetoproteins - analysis
Basiliximab
Biomarkers - analysis
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - pathology
Carcinoma, Hepatocellular - therapy
F-PET scan
Female
Hepatitis B
Hepatitis C
Humans
Immunosuppression
Immunosuppressive agents
Immunosuppressive Agents - therapeutic use
Induction therapy
Liver cancer
Liver diseases
Liver Neoplasms - mortality
Liver Neoplasms - pathology
Liver Neoplasms - therapy
Liver Transplantation
Liver transplants
Male
Medical imaging
Metastasis
Microvascular invasion
Middle Aged
Neoplasm Recurrence, Local
Original
PIVKA-II
Positron-Emission Tomography
Protein Precursors - analysis
Prothrombin - analysis
Regression Analysis
Risk Factors
Severity of Illness Index
Statistical analysis
Steroids
Survival analysis
Survival Rate
Tumors
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Summary: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. 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). 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
ISSN:2287-2728
2287-285X
DOI:10.3350/cmh.2014.20.2.192