Descriptive Analysis of Everolimus Conversion in Liver Transplant Recipients With Malignant Neoplastic Disease

• Published in: Transplantation proceedings 2020-03, Vol.52 (2), p.553-555
• Main Authors: Nogueras López, Flor, Espinosa Aguilar, Maria Dolores, Abellán Alfocea, Patricia, Ortega Suazo, Eva Julissa, González Sánchez, Mercedes, Redondo Cerezo, Eduardo, López Garrido, M. Angeles
• Format: Article
• Language: English
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2019.12.011

Calcineurin inhibitors are associated with the development of de novo tumors and increased recurrence of hepatocellular carcinoma after liver transplant. It has been suggested that mammalian target of rapamycin inhibitors (everolimus [EVR]) may improve prognosis. We analyzed our experience on the use of EVR in malignant neoplasms in liver transplantation. Methods. We performed a retrospective descriptive analysis of 477 transplants performed between 2002 and 2019 at Virgen de las Nieves Hospital. A total of 100 patients received EVR; 23 transplants were because of tumor disease (23%), with de novo tumor in 12 patients and hepatocarcinoma in 11. The statistical study was carried out using the statistical program SPSS 17.0 software. The study included 18 male patients (78.3%) and 5 female patients (21.7%) with an average age of 59.67 years. The most common indications of liver transplant have been alcoholic cirrhosis in 39% and hepatitis C virus cirrhosis in 21.7%. De novo tumors were lung neoplasm in 4 patients (33.3%), lymphoma in 2 patients(16.7%), oropharynx in 2 patients (16.7%), skin tumors in 2 patients (16.7%), and a kidney tumor (8.3%) in 1 patient. As for hepatocellular carcinoma, 8 patients met Milan criteria on the explant (61.5%). Tacrolimus was discontinued in all cases. The average onset time of post-transplant EVR was 2231.42 days in the de novo neoplasms and 307.45 days in those receiving transplants because of hepatocellular carcinoma (P = .05). We observed 5 deaths (21.7%). Although the beneficial long-term role of EVR in liver transplant recipients with tumor disease is not demonstrated, it is used by most transplant units, both in de novo neoplasms and those receiving transplants because of hepatocellular carcinoma. •After liver transplant because of hepatocellular carcinoma, patients who do not meet Milan criteria and have vascular microinvasion in the explant have a lower survival.•Malignant neoplasms after solid organ transplant are substantially more frequent than in the general population and remain a major cause of post-transplant mortality.•One of the best-documented associations between immunosuppression and risk of malignant neoplasms is for the calcineurin inhibitor class of drugs.•Everolimus appears to offer a potential option for reducing the risk for hepatocellular carcinoma recurrence after liver transplant and better survival with de novo tumors.