title: Sorafenib therapy for hepatocellular carcinoma prior to liver transplant is associated with increased complications after transplant.
abstract: This study compared post-transplant outcomes of patients with hepatocellular carcinoma (HCC) who took sorafenib prior to orthotopic liver transplantation (OLT) with those patients who were not treated with sorafenib. Thirty-three patients with HCC who were listed for liver transplantation were studied: 10 patients were treated with sorafenib prior to transplantation in an attempt to prevent progression of HCC while awaiting transplant. The remaining 23 patients were considered controls. The mean duration of sorafenib use was 19.2 (SD 25.2) weeks. Overall death rates were similar between the sorafenib group and control group (20% vs. 8.7%, respectively, P = 0.56). However, the patients in the sorafenib group had a higher incidence of acute cellular rejection following transplantation (67% vs. 22%, OR = 7.2, 95% CI 1.3-39.6, P = 0.04). The sorafenib group also had a higher rate of early biliary complications (67% vs. 17%, OR = 9.5, 1.6-55.0, P = 0.01). The use of sorafenib was found to be an independent predictor of post-transplant biliary complications (OR 12.6, 1.4-116.2, P = 0.03). Sorafenib administration prior to OLT appears to be associated with an increase in biliary complications and possibly in acute rejection following liver transplantation. Caution should be taken in this setting until larger studies are completed.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA 22908-0708, USA.
authors.forename: Aimee E
authors.initials: AE
authors.lastname: Truesdale
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Caldwell
authors.forename: Neeral L
authors.initials: NL
authors.lastname: Shah
authors.forename: Curtis K
authors.initials: CK
authors.lastname: Argo
authors.forename: Abdullah M S
authors.initials: AM
authors.lastname: Al-Osaimi
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Schmitt
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Northup
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use*; D001557:Benzenesulfonates / Q000009:adverse effects* / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000188:drug therapy*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009536:Niacinamide / Q000031:analogs & derivatives; D010671:Phenylurea Compounds; D010865:Pilot Projects; D011725:Pyridines / Q000009:adverse effects* / Q000627:therapeutic use*; D000077157:Sorafenib; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
chemical_list: D000970:Antineoplastic Agents; D001557:Benzenesulfonates; D010671:Phenylurea Compounds; D011725:Pyridines; D009536:Niacinamide; D000077157:Sorafenib