Factors affecting outcomes in liver transplant (LTx) recipients with hepatocellular carcinoma (HCC) and hepatitis C viral (HCV) infection include the choice of immunosuppression. Here, we analyzed the HCV+ subgroup of patients from the randomized controlled, international SiLVER Study. We performed a post hoc analysis of 166 HCV+ SiLVER Study patients regarding HCC outcome after LTx. Control patients (group A: n = 88) received mTOR inhibitor (mTORi)-free, calcineurin inhibitor (CNI)-based versus sirolimus-based immunosuppression (group B: n = 78). We found no significant difference regarding HCV-RNA titers between group A and B. Since no effect in group B could be due to variable sirolimus dosing, we split group B into patients receiving sirolimus-based immunosuppression + CNIs for >50% (B1; n = 44) or <50% (B2; n = 34) of the time. While there remained no difference in HCV-RNA titer between groups, HCC recurrence-free survival in group B1 (81.8%) was markedly better versus both group A (62.7%; P = 0.0136) and group B2 (64.7%; P = 0.0326); Interestingly, further subgroup analysis revealed an increase (P = 0.0012) in liver enzyme values in group B2. Taken together, in HCV-infected patients with HCC and LTx, mTORi immunosuppression + CNIs yields excellent outcomes. Unexpectedly, higher levels of liver inflammation and poorer outcomes occur with mTORi monotherapy in the HCV+ subgroup.

Werner, J., Hornung, M., Krah, R., Gotz, M., Schnitzbauer, A., Schlitt, H., et al. (2020). HCC recurrence in HCV-infected patients after liver transplantation: SiLVER Study reveals benefits of sirolimus in combination with CNIs – a post-hoc analysis. TRANSPLANT INTERNATIONAL, 33(8), 917-924 [10.1111/tri.13621].

HCC recurrence in HCV-infected patients after liver transplantation: SiLVER Study reveals benefits of sirolimus in combination with CNIs – a post-hoc analysis

Colledan M.;
2020

Abstract

Factors affecting outcomes in liver transplant (LTx) recipients with hepatocellular carcinoma (HCC) and hepatitis C viral (HCV) infection include the choice of immunosuppression. Here, we analyzed the HCV+ subgroup of patients from the randomized controlled, international SiLVER Study. We performed a post hoc analysis of 166 HCV+ SiLVER Study patients regarding HCC outcome after LTx. Control patients (group A: n = 88) received mTOR inhibitor (mTORi)-free, calcineurin inhibitor (CNI)-based versus sirolimus-based immunosuppression (group B: n = 78). We found no significant difference regarding HCV-RNA titers between group A and B. Since no effect in group B could be due to variable sirolimus dosing, we split group B into patients receiving sirolimus-based immunosuppression + CNIs for >50% (B1; n = 44) or <50% (B2; n = 34) of the time. While there remained no difference in HCV-RNA titer between groups, HCC recurrence-free survival in group B1 (81.8%) was markedly better versus both group A (62.7%; P = 0.0136) and group B2 (64.7%; P = 0.0326); Interestingly, further subgroup analysis revealed an increase (P = 0.0012) in liver enzyme values in group B2. Taken together, in HCV-infected patients with HCC and LTx, mTORi immunosuppression + CNIs yields excellent outcomes. Unexpectedly, higher levels of liver inflammation and poorer outcomes occur with mTORi monotherapy in the HCV+ subgroup.
Articolo in rivista - Articolo scientifico
direct-acting antiviral agents; hepatitis C virus infection; hepatocellular carcinoma; liver transplantation; Silver Study;
English
917
924
8
Werner, J., Hornung, M., Krah, R., Gotz, M., Schnitzbauer, A., Schlitt, H., et al. (2020). HCC recurrence in HCV-infected patients after liver transplantation: SiLVER Study reveals benefits of sirolimus in combination with CNIs – a post-hoc analysis. TRANSPLANT INTERNATIONAL, 33(8), 917-924 [10.1111/tri.13621].
Werner, J; Hornung, M; Krah, R; Gotz, M; Schnitzbauer, A; Schlitt, H; Geissler, E; Zulke, C; Lamby, P; Proneth, A; Duvoux, C; Burra, P; Jauch, K; Rentsch, M; Ganten, T; Schmidt, J; Settmacher, U; Heise, M; Rossi, G; Cillo, U; Kneteman, N; Adam, R; Hoek, B; Bachellier, P; Wolf, P; Rostaing, L; Bechstein, W; Rizell, M; Powell, J; Hidalgo, E; Gugenheim, J; Wolters, H; Brockmann, J; Roy, A; Mutzbauer, I; Schlitt, A; Beckebaum, S; Graeb, C; Nadalin, S; Valente, U; Turrion, V; Jamieson, N; Scholz, T; Colledan, M; Fandrich, F; Becker, T; Soderdahl, G; Chazouilleres, O; Makisalo, H; Pageaux, G; Steininger, R; Soliman, T; Jong, K; Pirenne, J; Margreiter, R; Pratschke, J; Pinna, A; Hauss, J; Schreiber, S; Strasser, S; Klempnauer, J; Troisi, R; Bhoori, S; Lerut, J; Bilbao, I; Klein, C; Konigsrainer, A; Otto, G; Mazzaferro, V; Neuhaus, P
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/365459
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