title: Meta-analysis: recurrence and survival following the use of sirolimus in liver transplantation for hepatocellular carcinoma.
abstract: BACKGROUND
  The use of sirolimus (SRL)-based immunosuppression protocols have been reported to reduce recurrence rates following liver transplantation (LT) for hepatocellular carcinoma (HCC), although this is still a matter for debate.
  
  
  OBJECTIVE
  To undertake a systematic review and meta-analysis of available literature on the usage of SRL as an immunosuppressive agent following LT for HCC, with a view to comparing cancer outcomes with the commonly used calcineurin inhibitors (CNIs).
  
  
  METHODS
  Systematic review and meta-analysis carried out in line with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Primary outcomes of interest were tumour recurrence rate and recurrence-free survival (RFS). Secondary outcomes were recurrence-related mortality and overall survival (OS).
  
  
  RESULTS
  In all, 5 studies met the inclusion criteria (n = 474). The recurrence rate was lower in SRL group (4.9-12.9%) in comparison with CNIs (17.3-38.7%). The 1-, 3- and 5-year RFS was 93-96%, 82-86% and 79-80% for SRL group, which was much better in comparison with the CNIs 70-78%, 64-65% and 54-60% respectively. Similarly, 1-, 3- and 5-year OS was much better for SRL group (94-95%, 85% and 80%) in comparison with CNIs (79-83%, 66% and 59-62%) respectively. Meta-analysis demonstrated lower recurrence (OR = 0.30, 95% CI = 0.16-0.55, P < 0.001), lower recurrence-related mortality (OR = 0.29, 95% CI = 0.12-0.70, P = 0.005) and lower overall mortality (OR = 0.35, 95% CI = 0.20-0.61, P < 0.001) for SRL group.
  
  
  CONCLUSIONS
  The review showed lower recurrence rate, longer recurrence-free survival and overall survival and lower recurrence-related mortality in sirolimus-treated patients in comparison with the calcineurin inhibitor-treated patients following liver transplantation for hepatocellular carcinoma.
authors.affiliation: Institute of Liver Studies, King's College Hospital, London, UK.
authors.forename: K V
authors.initials: KV
authors.lastname: Menon
authors.forename: A R
authors.initials: AR
authors.lastname: Hakeem
authors.forename: N D
authors.initials: ND
authors.lastname: Heaton
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000601:surgery*; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D020123:Sirolimus / Q000009:adverse effects / Q000627:therapeutic use*; D015996:Survival Rate
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus