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

한국간담췌외과학회지 2017년 21권 4호 p.205 ~ p.211

(Thorat Ashok) - China Medical University Hospital Organ Transplantation Center
(Jeng Long-Bin) - China Medical University Hospital Department of Surgery
(Yang Horng-Ren) - China Medical University Hospital Department of Surgery
(Yeh Chun-Chieh) - China Medical University Hospital Department of Surgery
(Hsu Shih-Chao) - China Medical University Hospital Department of Surgery
(Chen Te-Hung) - China Medical University Hospital Department of Surgery
(Poon Kin-Shing) - China Medical University Hospital Department of Anaesthesiology

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)

키워드

Everolimus, Living donor liver transplantation, Hepatocellular carcinoma, Hepatic artery thrombosis
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학술진흥재단(KCI) KoreaMed 대한의학회 회원 
주제코드
주제명(Target field)
연구대상(Population)
연구참여(Sample size)
대상성별(Gender)
질병특성(Condition Category)
연구환경(Setting)
연구설계(Study Design)
연구기간(Period)
중재방법(Intervention Type)
중재명칭(Intervention Name)
키워드(Keyword)
유효성결과(Recomendation)
EVR use in liver transplant recipients in the early stage after transplantation reduces the HCC recurrence rates among HCC patients within the UCSF criteria.
연구비지원(Fund Source)
근거수준평가(Evidence Hierarchy)
출판년도(Year)
참여저자수(Authors)
대표저자
KCD코드
ICD 03
건강보험코드