[Liver transplantation in patients with hepatocellular carcinoma]

Early steroid withdrawal regimen prevents new-onset diabetes mellitus in old-age recipients after living donor liver transplantation

BACKGROUND

Steroid use after liver transplantation is known to increase the risk of new-onset diabetes mellitus (NODM). In this study, we tried to identify a patient subgroup who would benefit with regard to NODM by an early steroid withdrawal regimen (ESWR) after living donor liver transplantation (LDLT) METHODS: Among 100 adult LDLT patients, 65 were on a conventional immunosuppressive regimen (CIR), and 35 were on an ESWR. With the ESWR, the steroid was tapered off mostly within 7 days with induction of basiliximab in combination with tacrolimus and mycophenolate mofetil (MMF). The CIR was a combination of tacrolimus and steroid. MMF was added in selected patients. Steroid was tapered off 2-6 months after LT. The presence of NODM was investigated cross-sectionally 6 months after LT.

RESULTS

There was no significant difference in terms of acute cellular rejection, sepsis, or death during follow-up. NODM had developed in 13 patients (13 %). Old recipient age (≥ 55) and pretransplant history of hypertension were significant risk factors for NODM. The type of immunosuppression was the single risk factor for NODM in subgroup of old-age recipients (≥ 55 years) on the CIR (hazard ratio 13.34, p = 0.04).

CONCLUSIONS

ESWR can safely reduce the incidence of NODM after LDLT in old-age recipients. Therefore, ESWR should be considered first in old-age recipients undergoing LDLT.

Liver transplantation for hepatocellular carcinoma: an analysis of 135 cases

AIM: To investigate the indications, contraindications, operative timing, and prevention and management of recurrence for liver transplantation in patient with hepatocellular carcinoma (HCC).

METHODS: A retrospective analysis was performed of 135 consecutive HCC patients who underwent liver transplantation (LT) from April 2005 to April 2010 at our center. The outcome of patients meeting Milan or UCSF criteria and those beyond UCSF criteria was compared.

RESULTS: There were no significant differences in 1- and 2-year survival rates and recurrence-free survival rate between patients meeting Milan criteria and those meeting UCSF criteria (97.0% vs 95.1%, 89.5% vs 78.6%, 91.0% vs 90.2%, 71.6% vs 65.6%; all P > 0.05). The 1-year survival rate and recurrence-free survival rate for patients beyond -UCSF criteria were 71.4% and 57.1%, respectively.

CONCLUSION: Liver transplantation is an effective means of treating HCC. Attention should be paid to postoperative adjustment of immunosuppressants to prevent tumor recurrence.