title: Rationale of personalized immunosuppressive medication for hepatocellular carcinoma patients after liver transplantation.
abstract: Liver transplantation is the only potentially curative treatment for hepatocellular carcinoma (HCC) that is not eligible for surgical resection. However, disease recurrence is the main challenge to the success of this treatment. Immunosuppressants that are universally used after transplantation to prevent graft rejection could potentially have a significant impact on HCC recurrence. Nevertheless, current research is exclusively focused on mammalian target of rapamycin inhibitors, which are thought to be the only class of immunosuppressive agents that can reduce HCC recurrence. In fact, substantial evidence from the bench to the bedside indicates that other classes of immunosuppressants may also exert diverse effects; for example, inosine monophosphate dehydrogenase inhibitors potentially have antitumor effects. In this article, we aim to provide a comprehensive overview of the potential effects of different types of immunosuppressants on HCC recurrence and their mechanisms of action from both experimental and clinical perspectives. To ultimately improve the outcomes of HCC patients after transplantation, we propose a concept and approaches for developing personalized immunosuppressive medication to be used either as immunosuppression maintenance or during the prevention/treatment of HCC recurrence.
authors.affiliation: Bio-X Center, College of Life Sciences, Zhejiang Sci-Tech University, Hangzhou, China; Department of Gastroenterology and Hepatology, Erasmus MC-University Medical Center, Rotterdam, the Netherlands.
authors.forename: Kan
authors.initials: K
authors.lastname: Chen
authors.forename: Kwan
authors.initials: K
authors.lastname: Man
authors.forename: Herold J
authors.initials: HJ
authors.lastname: Metselaar
authors.forename: Harry L A
authors.initials: HL
authors.lastname: Janssen
authors.forename: Maikel P
authors.initials: MP
authors.lastname: Peppelenbosch
authors.forename: Qiuwei
authors.initials: Q
authors.lastname: Pan
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000601:surgery*; D005938:Glucocorticoids / Q000627:therapeutic use; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007168:IMP Dehydrogenase / Q000037:antagonists & inhibitors; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery*; D016031:Liver Transplantation; D009364:Neoplasm Recurrence, Local; D009536:Niacinamide / Q000031:analogs & derivatives / Q000627:therapeutic use; D010671:Phenylurea Compounds / Q000627:therapeutic use; D000077157:Sorafenib; D058570:TOR Serine-Threonine Kinases / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D065095:Calcineurin Inhibitors; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D010671:Phenylurea Compounds; D009536:Niacinamide; D000077157:Sorafenib; D007168:IMP Dehydrogenase; C488211:IMPDH1 protein, human; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases