title: Conversion to sirolimus immunosuppression in liver transplantation recipients with hepatocellular carcinoma: Report of an initial experience.
abstract: OBJECTIVE
  To report a retrospective analysis of preliminary results of 36 patients who received sirolimus (SRL, Rapamune, rapamycin) in a consecutive cohort of 248 liver allograft recipients.
  
  
  METHODS
  Thirty-six liver transplant patients with hepatocellular carcinoma (HCC) who were switched to SRL-based immunosuppression therapy from tacrolimus were enrolled in this study. The patients who were diagnosed as advanced HCC before orthotopic liver transplantation (OLT) were divided into group A (n = 11), those who were found to have HCC recurrence and/or metastasis after OLT were assigned to group B (n = 18), and those who developed renal insufficiency caused by calcineurin inhibitor (CNI) were assigned to group C (n = 7) after OLT.
  
  
  RESULTS
  The patients were followed up for a median of 10.4 mo (range, 3.8-19.1 mo) after conversion to SRL therapy and 12.3 mo (range, 5.1-34.4 mo) after OLT. Three patients developed mild acute cellular rejection 2 wk after initiating SRL therapy, which was fully reversed after prednisolone pulse therapy. In group A, only 1 patient was found to have HCC recurrence and metastasis 12 mo after OLT. In group B, 66.7% (12/18) patients (2 with progressive tumor, 7 with stable tumor and 3 without tumor) were still alive due to conversing to SRL and/or resection for HCC recurrence at the end of a median follow-up of 6.8 mo post conversion and 10.7 mo posttransplant. In group C, no HCC recurrence was demonstrated in 7 patients, and renal function became normal after SRL therapy. Thrombocytopenia (n = 2), anemia (n = 8), and oral aphthous ulcers (n = 7) found in our cohort were easily manageable.
  
  
  CONCLUSIONS
  The conversion to SRL-based immunosuppression may inhibit the recurrence and metastasis of HCC and improve CNI-induced renal insufficiency in OLT patients with HCC.
authors.affiliation: Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai 200032, China. jianzhou@zshospital.net
authors.forename: Jian
authors.initials: J
authors.lastname: Zhou
authors.forename: Jia
authors.initials: J
authors.lastname: Fan
authors.forename: Zheng
authors.initials: Z
authors.lastname: Wang
authors.forename: Zhi-Quan
authors.initials: ZQ
authors.lastname: Wu
authors.forename: Shuang-Jian
authors.initials: SJ
authors.lastname: Qiu
authors.forename: Xiao-Wu
authors.initials: XW
authors.lastname: Huang
authors.forename: Yao
authors.initials: Y
authors.lastname: Yu
authors.forename: Jian
authors.initials: J
authors.lastname: Sun
authors.forename: Yong-Sheng
authors.initials: YS
authors.lastname: Xiao
authors.forename: Yi-Feng
authors.initials: YF
authors.lastname: He
authors.forename: Yu-Qi
authors.initials: YQ
authors.lastname: Wang
authors.forename: Zhao-You
authors.initials: ZY
authors.lastname: Tang
mesh_terms: D048868:Adaptor Proteins, Signal Transducing; D000328:Adult; D019703:Calcineurin / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000601:surgery*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000517:prevention & control; D010750:Phosphoproteins / Q000009:adverse effects; D051437:Renal Insufficiency / Q000139:chemically induced / Q000188:drug therapy; D012189:Retrospective Studies; D020123:Sirolimus / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use; D014180:Transplantation; D014184:Transplantation, Homologous
chemical_list: D048868:Adaptor Proteins, Signal Transducing; C491861:CABIN1 protein, human; D007166:Immunosuppressive Agents; D010750:Phosphoproteins; D019703:Calcineurin; D020123:Sirolimus; D016559:Tacrolimus