Steroid Free Immunosuppression Therapy For Liver Transplantation In HCC Patients

Background:Hepatitis B infections induced cirrhosis is the commonest risk factor of Hepatocellular carcinoma (HCC). It’s incidences in China are account for more than50%globally. Liver transplantation is considered as the most excellent solution for advanced HCC or not resectable tumor; not only it can removes the tumor but also correcting the underlying disease. Corticosteroid (Cs) is a non-specific anti-inflammatory and immunosuppressive agent that been used for a long time in organ transplantation. However, long term used also associated with numerous complications that increase morbidity and mortality. In recent years there has been an upward trend to limiting Cs use including reduce, early withdrawal, or even completely avoid it. The objective of this prospective study is to investigate the efficacy of steroid free regimen immunosuppression in clinical after liver transplantation in HCC patients. Methods:Between January2010and February2013, we selected30patients who had liver transplantation due to hepatocellular carcinoma (HCC). Immunosuppression regimen given was consisted of Tacrolimus as the main immunosuppression agent, along with mycophenolate mofetil. This study aims to evaluate the efficacy and safety of non-steroidal immunosuppression used for liver transplantation. Primary end point is patient and graft survival, second primary end point is to investigate the other clinical events that may relate to immunosuppression given.Results:Patient and rejection survival for12months was100%and86.6%respectively. Acute rejection occurred in13.4%and considered related to sub therapeutic tacrolimus blood levels. All rejections were completely reversible by temporary addition of steroids. HCC recurrence occurred in9of30patients, acute renal failure was seen in3patients, and was related to high tacrolimus blood levels. Hypertension occurred in7patients,24of30patients never received additional steroids and25patients were on a steroid-free maintenance regimen. Acute rejection survival analysis rate, patient and tumor free survival rate was calculated by Kaplan-Meier survival analysis.Conclusions:These results confirm that corticosteroid can be avoided in term to avoid patient being overload by immunosuppressions. Double therapy immunosuppression with tacrolimus and mycophenolate mofetil is effective and safe in terms of patient and graft survival as well as incidence and severity of rejection. Close drug level monitoring is suggested to avoid patient suffering from any adverse events.