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

Ju Yeun Lee, Yul Hee Kim, Nam Joon Yi, Hyang Sook Kim, Hye Suk Lee, Byung Koo Lee, Hyeyoung Kim, Young Rok Choi, Geun Hong, Kwang Woong Lee, Kyung Suk Suh

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

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.

Original languageEnglish
Pages (from-to)192-203
Number of pages12
JournalClinical and molecular hepatology
Volume20
Issue number2
DOIs
StatePublished - 2014

Bibliographical note

Publisher Copyright:
© 2014 by The Korean Association for the Study of the Liver.

Keywords

  • AFP
  • Basiliximab
  • F-PET scan
  • Immunosuppression
  • Microvascular invasion
  • PIVKA-II

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