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Sirolimus improved recurrence, survival rates after liver transplant in patients with HCC

Patients with hepatocellular carcinoma who undergo liver transplantation may be at reduced risk for disease recurrence and death when treated with sirolimus, according to recent results.

Researchers evaluated three retrospective studies and two prospective cohort studies involving 474 patients who received liver transplantation (LT) as treatment for hepatocellular carcinoma (HCC). The recurrence and survival rates of patients who subsequently received sirolimus (SRL)-based immunosuppression therapy were determined and compared against those treated with calcineurin inhibitors (CNI).

SRL recipients had lower recurrence rates (4.9% to 12.9% across evaluable studies compared with 17.3% to 38.7%), plus higher rates of recurrence-free survival (RFS) at 1 year (93% to 96% vs. 70% to 78%), 3 years (82% to 86% vs. 64% to 65%) and 5 years (79% to 80% vs. 54% to 60%) than patients treated with CNI. Overall survival (OS) rates among patients treated with SRL also were higher at 1 (94% to 95% vs. 79% to 83%), 3 (85% vs. 66%) and 5 years (80% vs. 59% to 62%).

Meta-analysis indicated significant associations between SRL use and recurrence rate (OR=0.30; 95% CI, 0.16-0.55) and overall mortality (OR=0.35; 95% CI, 0.20-0.61) and mortality related to recurrence (OR=0.29; 95% CI, 0.12-0.70) compared with CNI. No heterogeneity was observed between incorporated studies in any of the analyses.

“This review shows that SRL-based immunosuppression post-LT for HCC has improved patient outcomes with lower recurrence rates and significantly improved 1-, 3- and 5-year RFS and OS,” the researchers concluded, while noting that a lack of randomized trials and the low quality assessments and small study sample sizes posed review limitations. “Results from randomized studies … would help in proving the oncological benefit for SRL post-LT for HCC and the use of SRL-based immunosuppression protocols for the future.”