Conversion to sirolimus immunosuppression in liver transplantation recipients with hepatocellular carcinoma: Report of an initial experience

World J Gastroenterol. 2006 May 21;12(19):3114-8. doi: 10.3748/wjg.v12.i19.3114.


Aim: To report a retrospective analysis of preliminary results of 36 patients who received sirolimus (SRL, Rapamune, rapamycin) in a consecutive cohort of 248 liver allograft recipients.

Methods: Thirty-six liver transplant patients with hepatocellular carcinoma (HCC) who were switched to SRL-based immunosuppression therapy from tacrolimus were enrolled in this study. The patients who were diagnosed as advanced HCC before orthotopic liver transplantation (OLT) were divided into group A (n = 11), those who were found to have HCC recurrence and/or metastasis after OLT were assigned to group B (n = 18), and those who developed renal insufficiency caused by calcineurin inhibitor (CNI) were assigned to group C (n = 7) after OLT.

Results: The patients were followed up for a median of 10.4 mo (range, 3.8-19.1 mo) after conversion to SRL therapy and 12.3 mo (range, 5.1-34.4 mo) after OLT. Three patients developed mild acute cellular rejection 2 wk after initiating SRL therapy, which was fully reversed after prednisolone pulse therapy. In group A, only 1 patient was found to have HCC recurrence and metastasis 12 mo after OLT. In group B, 66.7% (12/18) patients (2 with progressive tumor, 7 with stable tumor and 3 without tumor) were still alive due to conversing to SRL and/or resection for HCC recurrence at the end of a median follow-up of 6.8 mo post conversion and 10.7 mo posttransplant. In group C, no HCC recurrence was demonstrated in 7 patients, and renal function became normal after SRL therapy. Thrombocytopenia (n = 2), anemia (n = 8), and oral aphthous ulcers (n = 7) found in our cohort were easily manageable.

Conclusion: The conversion to SRL-based immunosuppression may inhibit the recurrence and metastasis of HCC and improve CNI-induced renal insufficiency in OLT patients with HCC.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adaptor Proteins, Signal Transducing
  • Adult
  • Calcineurin / adverse effects
  • Carcinoma, Hepatocellular / drug therapy*
  • Carcinoma, Hepatocellular / surgery*
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use*
  • Incidence
  • Liver Neoplasms / drug therapy*
  • Liver Neoplasms / surgery*
  • Liver Transplantation*
  • Male
  • Middle Aged
  • Neoplasm Metastasis / drug therapy
  • Neoplasm Metastasis / prevention & control
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / prevention & control
  • Phosphoproteins / adverse effects
  • Renal Insufficiency / chemically induced
  • Renal Insufficiency / drug therapy
  • Retrospective Studies
  • Sirolimus / therapeutic use*
  • Tacrolimus / therapeutic use
  • Transplantation
  • Transplantation, Homologous


  • Adaptor Proteins, Signal Transducing
  • CABIN1 protein, human
  • Immunosuppressive Agents
  • Phosphoproteins
  • Calcineurin
  • Sirolimus
  • Tacrolimus