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Assessing the role of everolimus in reducing hepatocellular carcinoma recurrence after living donor liver transplantation for patients within the UCSF criteria: re-inventing the role of mammalian target of rapamycin inhibitors
Ann Hepatobiliary Pancreat Surg 2017 Nov;21(4):205-11
Published online November 30, 2017
Copyright © 2017 Ann Hepatobiliary Pancreat Surg.

Ashok Thorat1, Long-Bin Jeng1,2, Horng-Ren Yang1,2, Chun-Chieh Yeh1,2, Shih-Chao Hsu1,2, Te-Hung Chen1,2, and Kin-Shing Poon3

1Organ Transplantation Center, China Medical University Hospital, Departments of 2Surgery and 3Anaesthesiology, China Medical University Hospital, Taichung, Taiwan
Received April 26, 2017; Revised July 15, 2017; Accepted August 7, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Abstract
Backgrounds/Aims: The protective effect of everolimus (EVR) in hepatocellular carcinoma (HCC) patients who receive liver transplantation in terms of reducing the recurrence has not been sufficiently investigated in clinical trials. In this second stage of our ongoing study, we intend to analyze the effects of EVR as an immunosuppressant, when it is started in the early phase after living donor liver transplantation (LDLT), on HCC recurrence in patients with HCC within the University of California at San Francisco (UCSF) criteria. Methods: From January 2011 to June 2013, a total of 250 patients underwent LDLT for HCC at our institute. The patients with HCC within the UCSF criteria were included in the study and divided in two groups depending upon the postoperative immunosuppression. Group A: HCC patients that received EVR+TAC based immunosuppressive regimen (n=37). Group B: HCC patients that received standard TAC based immunosuppressive regimen without EVR (n=29). The target trough level for EVR was 3 to 5 ng/ml while for TAC it was 8-10 ng/ml. Results: For group A patients, the mean trough level of the EVR was 3.47±1.53 ng/ml (range, 1.5-11.2) with a daily dose of 1.00±0.25 mg/day. For group A and B, the average TAC trough levels were 6.97±3.98 ng/ml (range, 2.50 to 11.28 ng/ml) and 6.93±2.58 (range, 2-16.30), respectively. The 1-year, 3-year and 4-year overall survival achieved for Group A patients was 94.95%, 86.48% and 86.48%, respectively while for Group B patients it was 82.75%,68.96%, and 62.06%, respectively (p=0.0217).  Conclusions: EVR use in liver transplant recipients in the early stage after transplantation reduces the HCC recurrence rates in HCC patients within the UCSF criteria. (Ann Hepatobiliary Pancreat Surg 2017;21:205-211)
Keywords : Everolimus; Living donor liver transplantation; Hepatocellular carcinoma; Hepatic artery thrombosis

 

November 2018, 22 (4)