Epidemiology

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.