Sirolimus-based immunosuppression improves outcomes in liver transplantation recipients with hepatocellular carcinoma beyond the Hangzhou criteria

Sunbin Ling; Tingting Feng; Qifan Zhan; Xin Duan; Guangjiang Jiang; Tian Shen; Qiaonan Shan; Shengjun Xu; Qianwei Ye; Peng Liu; Beini Cen; Shusen Zheng; Xiao Xu

doi:10.21037/atm.2020.01.10

Sirolimus-based immunosuppression improves outcomes in liver transplantation recipients with hepatocellular carcinoma beyond the Hangzhou criteria

Ann Transl Med. 2020 Feb;8(4):80. doi: 10.21037/atm.2020.01.10.

Authors

Sunbin Ling^{1

2}, Tingting Feng^{1

2

3}, Qifan Zhan^{1

2}, Xin Duan^{1

2}, Guangjiang Jiang^{1

2}, Tian Shen^{1

2}, Qiaonan Shan^{1

2}, Shengjun Xu^{1

2}, Qianwei Ye^{1

2}, Peng Liu^{1

2

4}, Beini Cen², Shusen Zheng^{1

2}, Xiao Xu^{1

2}

Affiliations

¹ Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China.
² NHC Key Laboratory of Combined Multi-organ Transplantation, Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS, Hangzhou 310003, China.
³ Department of Abdominal Medical Oncology, Zhejiang Cancer Hospital, Hangzhou 310022, China.
⁴ Center of Organ Transplantation, the Affiliated Hospital of Qingdao University, Qingdao 266071, China.

Abstract

Background: The administration of calcineurin inhibitors (CNIs) posttransplant has been implicated as an independent risk factor for the recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT). The new immunosuppressive agent sirolimus (SRL) acts as a primary immunosuppressant or antitumor agent. In this study we investigated the effect of sirolimus-based immunosuppression compared to CNIs (non-SRL) on the outcomes of LT candidates with HCC.

Methods: We retrospectively analyzed 204 HCC patients who underwent LT in our hospital between January 2, 2014 and December 10, 2017. The median of the follow-up duration of patients was 24.5 months. The patients were divided into a sirolimus (SRL) group (76 patients) and a non-sirolimus (non-SRL) group (128 patients). Patients exceeding the LT criteria were analyzed as subgroups. Disease-free survival (DFS) and overall survival (OS) after tumor recurrence were compared using the Kaplan-Meier method. Univariate and multivariate Cox analyses were used to compare OS between the SRL and non-SRL groups.

Results: The SRL group achieved better OS compared to the non-SRL group, while there was no significant difference in DFS. Subgroup (Milan criteria-based or Hangzhou criteria-based) analyses revealed that patients exceeding, rather than meeting, the Milan or Hangzhou criteria benefited from SRL (exceeding the Milan criteria: P=0.002; exceeding the Hangzhou criteria: P<0.001). There was no significant difference in OS between the SRL group and the non-SRL group that met the Milan or Hangzhou criteria.

Conclusions: SRL can improve survival outcomes in LT patients with HCC exceeding the Hangzhou criteria.

Keywords: Sirolimus; hepatocellular carcinoma (HCC); liver transplantation (LT).