title: Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation.
abstract: OBJECTIVE
  The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated.
  
  
  METHODS
  Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ± 1.3 ng/mL (mean ± SD).
  
  
  RESULTS
  The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive (18)fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).
  
  
  CONCLUSIONS
  Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.
authors.affiliation: Department of Pharmacy, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. ; College of Pharmacy, Hanyang University, Gyeonggi-do, Korea.
authors.forename: Ju-Yeun
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Ewha Graduate School of Clinical Health Sciences, Ewha Women's University, Seoul, Korea.
authors.forename: Yul Hee
authors.initials: YH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.affiliation: Department of Pharmacy, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyang Sook
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Pharmacy, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hye Suk
authors.initials: HS
authors.lastname: Lee
authors.affiliation: Ewha Graduate School of Clinical Health Sciences, Ewha Women's University, Seoul, Korea.
authors.forename: Byung Koo
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hyeyoung
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Rok
authors.initials: YR
authors.lastname: Choi
authors.affiliation: Department of Surgery, Ewha Women's University College of Medicine, Seoul, Korea.
authors.forename: Geun
authors.initials: G
authors.lastname: Hong
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D049268:Positron-Emission Tomography; D011498:Protein Precursors / Q000032:analysis; D011516:Prothrombin / Q000032:analysis; D012044:Regression Analysis; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin
keywords: 18F-PET scan; AFP; Basiliximab; Immunosuppression; Microvascular invasion; PIVKA-II