Does mTORi base immunosuppression offer survival advantage after liver transplantation for hepatocellular carcinoma? Systematic review and meta-analysis of randomized controlled trials

Aloun, Ali

doi:10.14744/hf.2022.2022.0049

Cited by 2 publications

(1 citation statement)

References 32 publications

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“…The activation of mTOR pathway is closely related to the proliferation of HCC, tumor metabolic reprogramming and tumor angiogenesis [ 16 , 17 ]. As an mTOR inhibitor, sirolimus may decrease nontumour-related death by reducing the HCC recurrence rate in patients exceeding the transplant criteria [ 12 , 18 ]. Importantly, no deaths due to sepsis occurred in the sirolimus group among those who were beyond the Milan or Hangzhou criteria.…”

Section: Discussionmentioning

confidence: 99%

mTOR inhibitor reduces nontumour-related death in liver transplantation for hepatocellular carcinoma

Zhang,

Liu,

Zhuang

et al. 2024

Mol Biomed

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Sirolimus is a regularly applied immunosuppressant for patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). Sirolimus not only significantly inhibits HCC recurrence but also protects renal function. However, the improvement effect of sirolimus on nontumour-related death in patients is still unknown. The aim of our study was to investigate the therapeutic effect of sirolimus on nontumour-related deaths. In this study, we retrospectively enrolled 403 LT patients with HCC from January 1, 2015, to December 31, 2018. The median follow-up time was 47.1 months. The patients were divided into the sirolimus group (N = 184) and the sirolimus-free group (N = 219). There were no significant differences between the sirolimus group and the sirolimus-free group in survival (P = 0.054). In transplant patients who exceeded the Milan or Hangzhou criteria, the sirolimus group achieved higher survival than the sirolimus-free group (P = 0.005; P = 0.02). Moreover, multivariate analysis showed that sirolimus strongly reduced the hazard ratio (HR) for nontumour-related death in LT patients who exceeded the Milan (HR: 0.42; 95% CI: 0.18–1; P = 0.05) or Hangzhou criteria (HR: 0.26; 95% CI: 0.08–0.89; P = 0.032). HCC recurrence increased the risk of nontumour-related death. In conclusion, sirolimus-based immunosuppression can significantly reduce nontumour-related death in LT patients who exceed the criteria for transplantation. In addition, this finding will further promote the application of sirolimus after liver transplantation for hepatocellular carcinoma.

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Section: Discussionmentioning

confidence: 99%

mTOR inhibitor reduces nontumour-related death in liver transplantation for hepatocellular carcinoma

Zhang,

Liu,

Zhuang

et al. 2024

Mol Biomed

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Small Intestinal Adenocarcinoma Arising at the Anastomotic Site after Kasai Operation for Biliary Atresia: A Case Report and Literature Review

Ishikawa,

Saito,

Murakami

et al. 2023

Tohoku J. Exp. Med.

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Biliary atresia is an obliterative cholangiopathy of unknown etiology. Hepatic portoenterostomy, in which obliterated extrahepatic bile ducts are resected and bile flow is restored, known as Kasai operation, is performed within 3 months after birth. While this operation enhances long-term survival of patients, the occurrence of primary malignant hepatic tumors has been increasing. We report a case of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation. 49-year-old man, who underwent Kasai operation for biliary atresia when he was 2 months old, experienced rapidly progressive jaundice and liver dysfunction. Deceased-donor liver transplantation was performed for liver failure. Macroscopically, there was a white-yellow tumor located at the anastomotic site of hepatic portoenterostomy of the resected liver. Pathological examination revealed a well-differentiated adenocarcinoma with some Paneth cells in the neoplastic lesion. Immunohistochemically, the tumor cells were negative for CK7 but positive for CK20 and CDX2. Mucin expression in tumor cells was negative for MUC1 and MUC6 and positive for MUC2 and MUC5AC. The pathological diagnosis was small intestinal adenocarcinoma originating from the jejunum. The patient was discharged 48 days after the operation. The patient had not experienced recurrence at 10 months after the operation. This is the first report of small intestinal adenocarcinoma arising at the anastomotic site after Kasai operation for biliary atresia. Special care should be taken for the patients after Kasai operation with acute progressive jaundice and liver dysfunction, because there is a possibility of malignancy in their native liver.

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Does mTORi base immunosuppression offer survival advantage after liver transplantation for hepatocellular carcinoma? Systematic review and meta-analysis of randomized controlled trials

Cited by 2 publications

References 32 publications

mTOR inhibitor reduces nontumour-related death in liver transplantation for hepatocellular carcinoma

mTOR inhibitor reduces nontumour-related death in liver transplantation for hepatocellular carcinoma

Small Intestinal Adenocarcinoma Arising at the Anastomotic Site after Kasai Operation for Biliary Atresia: A Case Report and Literature Review

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