Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation
Korean Journal of Hepatology 2014³â 20±Ç 2È£ p.192 ~ p.203
ÀÌÁÖ¿¬(Lee Ju-Yeun) - Seoul National University College of Medicine Seoul National University Hospital Department of Pharmacy
±èÀ²Èñ(Kim Yul-Hee) - Ewha Womans University Ewha Graduate School of Clinical Health Sciences
À̳²ÁØ(Yi Nam-Joon) - Seoul National University College of Medicine Department of Surgery
±èÇâ¼÷(Kim Hyang-Sook) - Seoul National University College of Medicine Seoul National University Hospital Department of Pharmacy
ÀÌÇý¼÷(Lee Hye-Suk) - Seoul National University College of Medicine Seoul National University Hospital Department of Pharmacy
À̺´±¸(Lee Byung-Koo) - Ewha Womans University Ewha Graduate School of Clinical Health Sciences
±èÇý¿µ(Kim Hye-Young) - Seoul National University College of Medicine Department of Surgery
ÃÖ¿µ·Ï(Choi Young-Rok) - Seoul National University College of Medicine Department of Surgery
È«±Ù(Hong Geun) - Ewha Womans University College of Medicine Department of Surgery
À̱¤¿õ(Lee Kwang-Woong) - Seoul National University College of Medicine Department of Surgery
¼°æ¼®(Suh Kyung-Suk) - Seoul National University College of Medicine Department of Surgery
Abstract
Background/Aims: The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated.
Methods: Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ¡¾ 1.3 ng/mL (mean ¡¾ SD).
Results: The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).
Conclusions: Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.
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Immunosuppression, Basiliximab, Microvascular invasion, PIVKA-II, AFP, 18F-PET scan
KMID :
1103920140200020192
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