Reuters Health Information (2005-05-06): Cyclosporine may increase tumor recurrence after liver transplant
Cyclosporine may increase tumor recurrence after liver transplant
Last Updated: 2005-05-06 9:27:29 -0400 (Reuters Health)
NEW YORK (Reuters Health) - Exposure to high blood
levels of cyclosporine increases the risk of tumor recurrence after
liver transplantation for hepatocellular carcinoma (HCC), Italian
researchers report in the May issue of Liver Transplantation.
In fact, lead author Dr. Marco Vivarelli of the University of
Bologna told Reuters Health that "immunosuppression has to handled
carefully." The aim is "to reduce the dosage of calcineurin inhibitors
to the effective minimum."
Dr. Vivarelli and colleagues analyzed 70 consecutive HCC patients to
investigate the possible relationship between the type and degree of
immunosuppression and tumor recurrence after liver transplantation.
A third of patients (7 of 21) exposed to cyclosporine levels above
189.6 ng/mL experienced recurrence, compared with no recurrences in
patients exposed to lower levels, the authors report.
At all time points considered, mean cyclosporine blood levels were
higher in patients with tumor recurrence than in patients without
recurrence. They also had higher mean alpha-fetoprotein blood levels.
The authors thus conclude that "high-risk patients would probably
benefit from keeping the calcineurin inhibitors-based immunosuppression
as low as possible."
In an accompanying editorial, Dr. Myron Schwartz and colleagues from
Mount Sinai Hospital, New York observe that there is doubt about the
relationship "and the current paper does not convince us, but lacking
data from a randomized trial, it seems rational to use a
sirolimus-based regimen for patients in whom pathological examination
of the liver reveals a tumor with high risk for recurrence."
Liver Transpl 2005;11:497-503,494-496.