Trends of rapamycin in survival benefits of liver transplantation for hepatocellular carcinoma

Abstract

The proportion of liver transplantation (LT) for hepatocellular carcinoma (HCC) has kept on increasing over the past years and account for 20%-40% of all LT. Post-transplant HCC recurrence is considered the most important factor affecting the long-term survival of patients. The use of different types of immunosuppressive agents after LT is closely associated with an increased risk for HCC recurrence. The most commonly used conventional immunosuppressive drugs include the calcineurin inhibitors tacrolimus (FK506) and mammalian target of rapamycin inhibitor rapamycin (RAPA). Compared with tacrolimus, RAPA may carry an advantage in survival benefit because of its anti-tumor effects. However, no sufficient evidence to date has proven that RAPA could increase long-term recurrence-free survival and its anti-tumor mechanism of combined therapy remains incompletely clear. In this review, we will focus on recent advances in clinical application experience and basic research results of RAPA in patients undergoing LT for HCC to further guide the clinical practice.

Sirolimus vs tacrolimus: Which one is the best therapeutic option for patients undergoing liver transplantation for hepatocellular carcinoma?

“…We read with profound interest the review by Zhao et al [ 1 ], “Trends of rapamycin in survival benefits of liver transplantation for hepatocellular carcinoma”, published in the September 2021 issue of the World Journal of Gastrointestinal Surgery .…”

“…In the article, Zhao et al [ 1 ] highlight investigations involving the use of different types of potential options to treat post-LT recurrence in HCC patients. The study also compares immunosuppressive drugs such as the newer option first-generation mammalian target of rapamycin (mTOR) inhibitor, also known as sirolimus (SRL), with the most widely used first-generation calcineurin inhibitors (CNIs), such as tacrolimus (TAC).…”

“…Zhao et al [ 1 ] also cited the SiLVER trial, which demonstrated in the first three to five years an improved recurrence-free survival (RFS) and OS, especially in low-risk patients with tumor characteristics within Milan criteria[ 15 ]. Research conducted by Ekpanyapong et al [ 16 ] also supports this benefit.…”

“…The authors, Zhao et al [ 1 ], also mentioned one of the side effects of SRL, which is delayed wound healing, as a generally moderate and easy to treat condition. They stated that adverse reactions were subsided by lowering the installation rate or stopping the medicine, whereas a case report by Lao et al [ 20 ] presents a different scenario.…”

“…In conclusion, Zhao et al [ 1 ] presented interesting points concerning LT for HCC patients by the usage of SRL and TAC therapy. We agree with the authors’ insight that TAC significantly influences renal function, leading to acute and chronic kidney diseases after LT.…”