The role of calcineurin inhibitors in the progression of hepatocellular carcinoma after liver transplantation

Abstract

Introduction. Orthotopic liver transplantation is the most radical method of treatment of hepatocellular carcinoma. The high recurrence rate limits the use of transplantation in patients with hepatocellular cancer. Immunosuppressive therapy may affect the frequency of oncoprogression after liver transplantationAim. To evaluate the role of immunosuppressive therapy in the postoperative progression of hepatocellular cancer in patients after liver transplantationMaterial and methods. The recurrence rate of hepatocellular cancer and tumor free survival in 104 patients after liver transplantation were analyzed. To evaluate the effect of the immunosuppression main component concentration on the postoperative progression of hepatocellular carcinoma, we studied the mean baseline concentration (C0) for the entire follow-up period for patients with a tumor-free period and the mean baseline concentration for patients with hepatocellular carcinoma progression, in whom only the duration of the tumor-free period was studied. According to the degree of tumor lesion, patients were distributed in accordance with the Milan criteria (based on the results of a pathologic and morphological examination of the recipient's explanted liver.Results. The values of the baseline blood level of tacrolimus>6.0 ng/ml and cyclosporine A>100 ng/ml is associated with a high rate of progression of hepatocellular cancer. Reducing the load of calcineurin inhibitors can reduce the incidence of cancer progression by at least 2 times. The values of 1-, 3- and 5-year relapse-free survival in patients with advanced cancer and low figures of the baseline blood level of calcineurin inhibitor are 82%, 70% and 70%, respectively.Conclusion. Minimization of immunosuppression is of crucial importance in the prevention of posttransplant progression of hepatocellular cancer, especially among patients with its common form.