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Liver transplantation: immunosuppression and oncology

Rodríguez-Perálvarez, Manuela; De la Mata, Manuela; Burroughs, Andrew K.b,c

Current Opinion in Organ Transplantation: June 2014 - Volume 19 - Issue 3 - p 253–260
doi: 10.1097/MOT.0000000000000069

Purpose of review Long-term survival of liver transplant recipients is threatened by increased rates of de-novo malignancy and recurrence of hepatocellular carcinoma (HCC), both events tightly related to immunosuppression.

Recent findings There is accumulating evidence linking increased exposure to immunosuppressants and carcinogenesis, particularly concerning calcineurin inhibitors (CNIs), azathioprine and antilymphocyte agents. A recent study including 219 HCC transplanted patients showed that HCC recurrence rates were halved if a minimization of CNIs was applied within the first month after liver transplant. With mammalian target of rapamycin (mTOR) inhibitors as approved immunosuppressants for liver transplant patients, pooled data from several retrospective studies have suggested their possible benefit for reducing HCC recurrence.

Summary Randomized controlled trials with sufficiently long follow-up are needed to evaluate the influence of different immunosuppression protocols in preventing malignancy after LT. Currently, early minimization of CNIs with or without mTOR inhibitors or mycophenolate seems a rational strategy for patients with risk factors for de-novo malignancy or recurrence of HCC after liver transplant. A deeper understanding of the immunological pathways of rejection and cancer would allow for designing more specific and safer drugs, and thus to prevent cancer after liver transplant.

aDepartment of Hepatology and Liver Transplantation. Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain

bThe Royal Free Sheila Sherlock Liver Centre and Institute of Liver and Digestive Health, UCL, London, United Kingdom


Correspondence to Manuel Rodríguez-Perálvarez, MD, PhD, Department of Hepatology and Liver Transplantation. Reina Sofía University Hospital, IMIBIC, CIBERehd, Córdoba, Spain. E-mail:

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© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins