Conversion to everolimus dramatically improves the prognosis of de novo malignancies after liver transplantation for alcoholic liver disease.

Abstract

De novo malignancies are a main cause for late death after liver transplantation (LT). Everolimus (ERL) is an immunosuppressive agent with antitumoral properties. The aim of the present retrospective study was to identify prognostic factors, including conversion to ERL, for patients presenting non-cutaneous de novo solid organ malignancy after LT for alcoholic cirrhosis. The study population consisted of 83 patients (presenting 100 tumors, including 75% of upper aerodigestive tract cancers), among the 398 patients who underwent LT for alcoholic cirrhosis in our center. After diagnosis, ERL was introduced in 38 patients and calcineurin-inhibitor was discontinued in 64.1% of them. Tumor stage was a significant prognostic factor with a one-yr survival at 82.6% for early stages, 63.4% for intermediate stages (N+) and 27.4% for disseminated diseases (p < 0.001). Associated relative risk factor was 2.202 (95% CI 1.044-4.644) for intermediate stages and 5.743 (95% CI 2.436-13.541) for metastatic stages. One- and five-yr survival was 77.4% and 35.2% in ERL group vs. 47.2% and 19.4% in the non-ERL group, respectively (p = 0.003). The relative risk factor for ERL was 0.447 (95%CI 0.257-0.778). Our results strongly suggest that conversion to ERL improves the prognosis of de novo malignancies after LT for alcoholic cirrhosis. Prospective studies are needed to confirm this benefit.

• Authors: Elsa Thimonier, Olivier Guillaud, Thomas Walter, Evelyne Decullier, Mélanie Vallin, Olivier Boillot, Jérôme Dumortier
• Journal: Clinical transplantation (Clin Transplant) Vol. 28 Issue 12 Pg. 1339-48 (Dec 2014) ISSN: 1399-0012 [Electronic] Denmark
• PMID: 25081431 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Immunosuppressive Agents
• Everolimus
• Sirolimus

Topics

• Adult
• Aged
• Everolimus
• Female
• Follow-Up Studies
• Humans
• Immunosuppressive Agents (therapeutic use)
• Liver Cirrhosis, Alcoholic (surgery)
• Liver Transplantation
• Male
• Middle Aged
• Neoplasms (etiology, mortality, prevention & control)
• Postoperative Complications
• Prognosis
• Retrospective Studies
• Risk Factors
• Sirolimus (analogs & derivatives, therapeutic use)
• Survival Rate