title: Everolimus-based immunosuppression in patients with hepatocellular carcinoma at high risk of recurrence after liver transplantation: a case series.
abstract: BACKGROUND
  Liver transplantation offers the most effective treatment in patients with hepatocellular carcinoma (HCC). However, transplant patients outside the Milan criteria have a high risk of tumor recurrence, which has been linked to standard immunosuppression regimens. Everolimus is a mammalian target of rapamycin inhibitor that has been used for immunosuppression, but its effect on recurrence and survival in HCC patients with a high risk of tumor recurrence has not been examined. We compared long-term survival and cumulative recurrence in high-risk patients receiving everolimus-based immunosuppression after liver transplantation for HCC with an historic control group.
  
  
  METHODS
  The everolimus group comprised 21 patients receiving a liver transplant at our center from February 2005 to December 2010. The control group comprised 31 patients receiving a liver transplant from May 1994 to January 2005. All patients received cyclosporine or tacrolimus as initial post-transplant immunosuppression. Patients in the everolimus group switched to everolimus 2 weeks later.
  
  
  RESULTS
  There were no differences between the two groups in number of rejection episodes or of infectious or surgical complications. Five-year survival was 60.2% in the everolimus group and 32.3% in the control group (P = .05). Five-year cumulative recurrence rate was 61.3% in the control group and 41.3% in the everolimus group. Treatment with everolimus was identified as an independent predictor of longer survival (hazard ratio = 0.34; P = .02).
  
  
  CONCLUSIONS
  Patients receiving liver transplantation for HCC with a high risk of tumor recurrence may well benefit from everolimus-based immunosuppression, with no added risks of rejection or other post-transplant complications.
authors.affiliation: Liver Transplant Unit, A Coruña Hospital, A Coruña, Spain.
authors.forename: A O
authors.initials: AO
authors.lastname: Ferreiro
authors.affiliation: Liver Transplant Unit, A Coruña Hospital, A Coruña, Spain. Electronic address: maria.angeles.vazquez.millan@sergas.es.
authors.forename: M A
authors.initials: MA
authors.lastname: Vazquez-Millán
authors.affiliation: Liver Transplant Unit, A Coruña Hospital, A Coruña, Spain.
authors.forename: F S
authors.initials: FS
authors.lastname: López
authors.affiliation: Liver Transplant Unit, A Coruña Hospital, A Coruña, Spain.
authors.forename: M G
authors.initials: MG
authors.lastname: Gutiérrez
authors.affiliation: Clinical Epidemiology and Biostatistics Unit, A Coruña Hospital, A Coruña, Spain.
authors.forename: S P
authors.initials: SP
authors.lastname: Diaz
authors.affiliation: Pathology Service, A Coruña Hospital, A Coruña, Spain.
authors.forename: M J L
authors.initials: MJ
authors.lastname: Patiño
mesh_terms: D000970:Antineoplastic Agents; D006528:Carcinoma, Hepatocellular / Q000188:drug therapy* / Q000601:surgery; D000068338:Everolimus; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000068338:Everolimus; D020123:Sirolimus