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KMID : 1040620210270040589
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Clinical and Molecular Hepatology
2021 Volume.27 No. 4 p.589 ~ p.602
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Impact of everolimus on survival after liver transplantation for hepatocellular carcinoma
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Kang In-Cheon
Lee Jae-Geun
Choi Sung-Hoon
Kim Hyun-Jeong
Han Dai-Hoon
Choi Gi-Hong
Kim Myoung-Soo
Choi Jin-Sub
Kim Soon-Il
Joo Dong-Jin
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Abstract
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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.
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KEYWORD
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Hepatocellular carcinoma, Liver transplantation, Immunosuppression, Recurrence, Survival
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