Hepatocellular Carcinoma Recurrence Among Liver Transplant Recipients Within the Milan Criteria

Felga, Guilherme Eduardo Gonçalves; Evangelista, Ana Catarina Jorge; Salvalaggio, Paolo R.O.; Curvêlo, Lílian Amorim; Guardia, Bianca Della; Almeida, Márcio Dias de; Afonso, R.C.; Ferraz-Neto, Ben Hur

doi:10.1016/j.transproceed.2012.07.004

Cited by 8 publications

(18 citation statements)

References 20 publications

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“…Recurrent HCV infection after liver transplantation is universal and is associated with accelerated liver fibrogenesis, leading to allograft cirrhosis in at least 30% of patients within 5 years of transplantation 16,17. Posttransplant HCC recurrence has been reported in up to 20% of patients;18 although lower incidence (<10%) has been reported among the patients within the Milan criteria 19,20. Recurrence of primary sclerosing cholangitis has been reported in 10%–38.7% of liver transplant recipients 21…”

Section: Introduction To Liver Transplantationmentioning

confidence: 99%

The role of everolimus in liver transplantation

Ganschow¹,

Pollok²,

Jankofsky³

et al. 2014

CEG

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During the last 5 decades, liver transplantation has witnessed rapid development in terms of both technical and pharmacologic advances. Since their discovery, calcineurin inhibitors (CNIs) have remained the standard of care for immunosuppression therapy in liver transplantation, improving both patient and graft survival. However, adverse events, particularly posttransplant nephrotoxicity, associated with long-term CNI use have necessitated the development of alternate treatment approaches. These include combination therapy with a CNI and the inosine monophosphate dehydrogenase inhibitor mycophenolic acid and use of mammalian target of rapamycin (mTOR) inhibitors. Everolimus, a 40-O-(2-hydroxyethyl) derivative of mTOR inhibitor sirolimus, has a distinct pharmacokinetic profile. Several studies have assessed the role of everolimus in liver transplant recipients in combination with CNI reduction or as a CNI withdrawal strategy. The efficacy of everolimus-based immunosuppressive therapy has been demonstrated in both de novo and maintenance liver transplant recipients. A pivotal study in 719 de novo liver transplant recipients formed the basis of the recent approval of everolimus in combination with steroids and reduced-dose tacrolimus in liver transplantation. In this study, everolimus introduced at 30 days posttransplantation in combination with reduced-dose tacrolimus (exposure reduced by 39%) showed comparable efficacy (composite efficacy failure rate of treated biopsy-proven acute rejection, graft loss, or death) and achieved superior renal function as early as month 1 and maintained it over 2 years versus standard exposure tacrolimus. This review provides an overview of the efficacy and safety of everolimus-based regimens in liver transplantation in the de novo and maintenance settings, as well as in special populations such as patients with hepatocellular carcinoma recurrence, hepatitis C virus-positive patients, and pediatric transplant recipients. We also provide an overview of ongoing studies and discuss potential expansion of the role for everolimus in these settings.

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Section: Introduction To Liver Transplantationmentioning

confidence: 99%

The role of everolimus in liver transplantation

Ganschow¹,

Pollok²,

Jankofsky³

et al. 2014

CEG

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“…This form of HCC spreads between multiple organs, commonly seen in the lungs and in bone (Roberts, 2005). The studies produced by Vagefi et al (2015), Felga et al(2012), and Varona et al (2015) had similar findings, with recorded incidence of 6.5%, 6.9%, and 7%, respectively. Research performed by Fisher et al (2007), Bonadio et al (2015), and Kornberg et al (2015) identified higher incidence, reported at 18%, 22%, and 23.3%, respectively.…”

Section: Incidencementioning

confidence: 59%

“…For example, in the study by Chaiteerakij et al (2015), patients within the Milan criteria experienced a recurrence rate of 8%, while patients outside of this criteria experienced a recurrence rate of 41%. In another study by Felga et al (2012), patients within the Milan criteria had a recurrence rate of 6.9%. While the Milan criteria is not a perfect indicator of recurrence, the accuracy has been significant enough to be used as one of the top predictors of HCC recurrence in liver transplantation patients.…”

Section: Significant Risk Factorsmentioning

confidence: 94%

“…Three studies analyzed in the literature review followed this rule, with Vagefi et al (2015) having an incidence of 6.5% for 324 patients, Varona et al (2015) with an incidence of 7% for 480 patients, and Felga et al (2012) with an incidence of 6.9% for 603 patients. These studies were larger in scope and sample size compared to the data collected from OHSU.…”

Section: Incidencementioning

confidence: 99%

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Hepatocellular Carcinoma Recurrence After Liver Transplantation: An Analysis of Risk Factors and Incidence from Oregon Health Science University

Hubsky

2016

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“…Çünkü bu kriterler dışında, tümörün diğer özelliklerinin de nüks ve sağkalım üzerine olan etkisi daha önce yapılan birçok çalışmada ortaya konulmuştur (14,18). Çalışmamızda da bu sonuçlara paralel olarak kanser nüksünü arttıran faktörler arasında; tümörün çapı, multifokal ve kötü diferansasyon göstermesinin önemli olduğu görüldü.…”

Section: Discussionunclassified

Hepatocellular carcinoma and living donor liver transplantation; the factors associated with recurrence and survival of patients. A single center experience

Günay¹,

Guler²,

Akyıldız³

et al. 2013

Gaziantep Med J

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Liver transplantation is considered to be the most effective treatment for hepatocellular cancer (HCC) arising in the setting of cirrhosis. However, HCC recurrence remains a concern after liver transplantation. In this study, our goal was to investigate the factors associated with recurrence and survival of the patients after living donor liver transplantation. One hundred and nine patients underwent living donor liver transplantation due to hepatocellular cancer were included in the study. The average age was 55.2±7.82 (26-72) years and 89% of patients were male. Of the 109 patients, 57 (52.3%) met Milan criteria. The mean tumor size was 36.44±22.64 (5-140) mm and 55% of tumor had multifocality. Sixteen (14.7%) patients developed tumor recurrence in a mean follow up of 31.4±26.2 (4-94) months. Tumor size, poor differentiation and hepatitis B recurrence were associated with higher tumor recurrence and lower survival rate. Although tumors outside the Milan criteria were associated with high recurrence, they did not affect survival rate. The survival rate was lower in patients with tumor recurrence. Of the 109 patients, 87 (75.2%) were alive while 27 (24.8%) were deceased. The overall survival rates at first year in patients with recurrence and without recurrence were 54.27±12.89% and 85.54±4.36% respectively. In conclusion, tumor recurrence decreases patients survival rate after living donor liver transplantation performed for HCC. In order to predict both tumor recurrence and patient survival, all other tumor characters should be evaluated with the Milan criteria prior to transplantation.

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Hepatocellular Carcinoma Recurrence Among Liver Transplant Recipients Within the Milan Criteria

Cited by 8 publications

References 20 publications

The role of everolimus in liver transplantation

The role of everolimus in liver transplantation

Hepatocellular Carcinoma Recurrence After Liver Transplantation: An Analysis of Risk Factors and Incidence from Oregon Health Science University

Hepatocellular carcinoma and living donor liver transplantation; the factors associated with recurrence and survival of patients. A single center experience

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