Therapeutic strategies for post-transplant recurrence of hepatocellular carcinoma  

作　　者：Carlo Sposito Davide Citterio Matteo Virdis Carlo Battiston Michele Droz Dit Busset Maria Flores Vincenzo Mazzaferro 

机构地区：[1]HPB Surgery,Hepatology and Liver Transplantation,Fondazione IRCCS Istituto Nazionale Tumori di Milano,Milan 20133,Italy [2]Department of Oncology and Hemato-Oncology,University of Milan,Milan 20100,Italy

出　　处：《World Journal of Gastroenterology》2022年第34期4929-4942,共14页世界胃肠病学杂志（英文版）

摘　　要：Despite stringent selection criteria,hepatocellular carcinoma recurrence after liver transplantation(LT)still occurs in up to 20%of cases,mostly within the first 2–3 years.No adjuvant treatments to prevent such an occurrence have been developed so far.However,a balanced use of immunosuppression with minimal dose of calcineurin inhibitors and possible addition of mammalian target of rapamycin inhibitors is strongly advisable.Moreover,several pre-and posttransplant predictors of recurrence have been identified and may help determine the frequency and duration of post-transplant follow-up.When recurrence occurs,the outcomes are poor with a median survival of 12 mo according to most retrospective studies.The factor that most impacts survival after recurrence is timing(within 1–2 years from LT according to different authors).Several therapeutic options may be chosen in case of recurrence,according to timing and disease presentation.Surgical treatment seems to provide a survival benefit,especially in case of late recurrence,while the benefit of locoregional treatments has been suggested only in small retrospective studies.When systemic treatment is indicated,sorafenib has been proved safe and effective,while only few data are available for lenvatinib and regorafenib in second line.The use of immune checkpoint inhibitors is controversial in this setting,given the safety warnings for the risk of acute rejection.

关 键 词：Liver transplantation Hepatocellular carcinoma IMMUNOSUPPRESSION RECURRENCE Surgical treatment Locoregional treatment Systemic treatment 

分 类 号：R735.7[医药卫生—肿瘤]