title: Immunosuppression Strategies in the Treatment of Hepatocellular Carcinoma in Virgen de las Nieves University Hospital.
abstract: BACKGROUND
  We describe an observational, retrospective study that included patients who underwent a liver transplantation (LT) for hepatocellular carcinoma (HCC) in our center between 2004 and 2012.
  
  
  METHODS
  Clinical variables were recorded for donors and recipients as diagnosis and treatment, immunosuppressive therapy, toxicity, graft dysfunction, recurrence, and exitus. Fifty-eight patients were analyzed. The mean age was 57 ± 8 years. The viral etiology of HCC was 50% (n = 29), alcoholic 26% (n = 15), and others, 24% (n = 14). Regarding initial immunosuppressive strategy (IS), 51 patients (87.9%) were treated with standard regimen with corticosteroids (CS) and tacrolimus (TA), compared with 7 patients with impaired renal function (12.1%) who underwent a delayed therapy with calcineurin inhibitors (CNI) + mycophenolate mophetil (MMF) + CS. Concomitant use of anti-CD25 monoclonal antibodies was less than 10%. Regarding maintenance, 43 patients (74.1%) were treated with MMF + CNI versus 15 treated only with TA (25.9%).
  
  
  RESULTS
  Recurrence of HCC was approximately 12%: 7 patients (2 hepatic only, 5 also extra-hepatic). Exitus was established in 19 patients (32.75%); only 3 patients (5.17%) were attributable to HCC. Bivariate studies were conducted according to the initial IS (standard regimen versus delayed therapy) and maintenance therapy (MMF + TA versus TA alone), with no differences in any of them in recurrence, treatment toxicity, graft rejection, and dysfunction.
  
  
  CONCLUSIONS
  In our experience with the IS, we found no differences in the development of recurrent disease, treatment toxicity, development of graft dysfunction, or rejection. We believe that individualized immunosuppressive therapy in these patients is safe and effective.
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain. Electronic address: sanmiguel.carlos@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: San Miguel
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: Y
authors.initials: Y
authors.lastname: Fundora
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Triguero
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: K
authors.initials: K
authors.lastname: Muffak
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: T
authors.initials: T
authors.lastname: Villegas
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Becerra
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Garrote
authors.affiliation: General, Digestive Surgery, and Liver Transplantation Department, Virgen de las Nieves University Hospital, Granada, Spain.
authors.forename: J A
authors.initials: JA
authors.lastname: Ferrón
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D065095:Calcineurin Inhibitors / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006085:Graft Survival; D006785:Hospitals, University; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D053645:Interleukin-2 Receptor alpha Subunit / Q000037:antagonists & inhibitors; D008113:Liver Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local; D051437:Renal Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use*
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D065095:Calcineurin Inhibitors; C508017:IL2RA protein, human; D007166:Immunosuppressive Agents; D053645:Interleukin-2 Receptor alpha Subunit; D009173:Mycophenolic Acid; D016559:Tacrolimus