Sirolimus improves the prognosis of liver recipients with hepatocellular carcinoma: A single-center experience

• Published in: Hepatobiliary & pancreatic diseases international Vol. 22; no. 1; pp. 34 - 40
• Main Authors: Liu, Peng, Wang, Xin, Liu, Huan, Wang, Shu-Xian, Xu, Qing-Guo, Wang, Lin, Xu, Xiao, Cai, Jin-Zhen
• Format: Journal Article
• Language: English
• Published: Singapore Elsevier B.V 01.02.2023; Organ Transplantation Center,The Affiliated Hospital of Qingdao University,Qingdao 266100,China; Institute of Organ Donation and Transplantation,Department of Medicine,Qingdao University,Qingdao 266100,China%Institute of Organ Donation and Transplantation,Department of Medicine,Qingdao University,Qingdao 266100,China%Organ Transplantation Center,The Affiliated Hospital of Qingdao University,Qingdao 266100,China%Department of Hepatobiliary and Pancreatic Surgery,The Center for Integrated Oncology and Precision Medicine,Affiliated Hangzhou First People's Hospital,Zhejiang University School of Medicine,Hangzhou 310003,China; Institute of Organ Transplantation,Zhejiang University,Hangzhou 310003,China; National Health Commission(NHC)Key Laboratory of Combined Multi-Organ Transplantation,Hangzhou 310003,China
• Subjects: Carcinoma, Hepatocellular - drug therapy; Carcinoma, Hepatocellular - surgery; Hepatocellular carcinoma; Humans; Liver Neoplasms - pathology; Liver transplantation; Neoplasm Recurrence, Local; Overall survival; Prognosis; Recurrence-free survival; Retrospective Studies; Sirolimus; Sirolimus - adverse effects; Tumor recurrence; Hepatocellular carcinoma; Recurrence-free survival; Sirolimus; Tumor recurrence; Overall survival; Liver transplantation
• ISSN: 1499-3872
• DOI: 10.1016/j.hbpd.2022.11.010

Tumor recurrence after liver transplantation (LT) for selective patients diagnosed with hepatocellular carcinoma (HCC) in the setting of cirrhosis is the greatest challenge effecting the prognosis of these patients. The aim of this study was to evaluate the efficacy of sirolimus on the prognosis for these recipients. The data from 193 consecutive HCC patients who had undergone LT from January 2015 to December 2019 were retrospectively analyzed. These patients were divided into the sirolimus group [patients took sirolimus combined with calcineurin inhibitors (CNIs) (n = 125)] and non-sirolimus group [patients took CNI-based therapy without sirolimus (n = 68)]. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. The prognostic factors and independent risk factors for RFS and OS were further evaluated. Non-sirolimus was an independent risk factor for RFS (HR = 2.990; 95% CI: 1.050-8.470; P = 0.040) and OS (HR = 3.100; 95% CI: 1.190-8.000; P = 0.020). A higher proportion of patients beyond Hangzhou criteria was divided into the sirolimus group (69.6% vs. 80.9%, P = 0.030). Compared with the non-sirolimus group, the sirolimus group had significantly better RFS (P < 0.001) and OS (P < 0.001). Further subgroup analysis showed similar results. This study demonstrated that sirolimus significantly decreased HCC recurrence and prolonged RFS and OS in LT patients with different stage of HCC.