Optimization of immunosuppressive medication upon liver transplantation against HCC recurrence

Assessing the Impact of Suboptimal Donor Characteristics on Mortality After Liver Transplantation: A Time-dependent Analysis Comparing HCC With Non-HCC Patients

“…Similarly, differences in the incidence of acute rejection do not explain the differences in the survival patterns of HCC and non-HCC recipients. In efforts to reduce the risk of tumour recurrence, HCC recipients can be subjected to more conservative immunosuppression protocols 27 and therefore they may be at an increased risk of acute rejection. However, we have found that 1-year readmissions for acute rejection in patients transplanted in the UK between 2008 and 2016 occurred less frequently in HCC recipients (2.8% Or 35/1270) than in non-HCC recipients (3.1% Or 112/3657, p=0.57) whilst acute rejection recorded as a cause of death was not identified at all within the study cohort (London School of Hygiene and Tropical Medicine, unpublished observations).…”

Center-driven and Clinically Driven Variation in US Liver Transplant Maintenance Immunosuppression Therapy: A National Practice Patterns Analysis

“…Hepatocellular cancer recurrence is believed to be influenced by degree of ISx, is difficult to treat, and leads to high mortality. 10 The mTORi-based regimens may have some antineoplastic benefits for patients with HCC. 11 Although the use of sirolimus (SRL) is particularly challenging early posttransplant due to risk of vascular complications and poor wound healing, selected trials have suggested benefit if therapy is delayed for at least 30 days.…”

Liver transplantation for hepatocellular carcinoma: Management after the transplant

“…Role of azathioprine as carcinogen; Although MMF has an antiangiogenesis and antiproliferative action it has not been shown to decrease HCC recurrence; however, it is used in order to decrease CNI levels Induction agents 116,117 Antithymocyte globulin (ATG) and Basiliximab role unclear by themselves Helpful in reducing CNI levels, but because of their disappearing effect on CD25 + cells, including tumor specific cytotoxic T cells, their overall effect is not clear mTOR inhibitors (sirolimus and everolimus) [118][119][120][121][122][123][124] Possibly decreasing HCC recurrence, although data not clear Anticancer properties through mTOR inhibition, although when treatment is initiated may be critical regarding effectiveness; everolimus may stabilize HCC progression HCC, hepatocellular carcinoma; LT, liver transplantation; mTOR, mammalian target of rapamycin.…”