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KMID : 1103920140200020192
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Korean Journal of Hepatology
2014 Volume.20 No. 2 p.192 ~ p.203
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Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation
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Lee Ju-Yeun
Kim Yul-Hee
Yi Nam-Joon
Kim Hyang-Sook
Lee Hye-Suk
Lee Byung-Koo
Kim Hye-Young
Choi Young-Rok
Hong Geun
Lee Kwang-Woong
Suh Kyung-Suk
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Abstract
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Background/Aims: 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.
Methods: 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).
Results: 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<0.05). High AFP and PIVKA-II levels, and positive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).
Conclusions: Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.
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KEYWORD
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Immunosuppression, Basiliximab, Microvascular invasion, PIVKA-II, AFP, 18F-PET scan
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