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Treating ischaemia-reperfusion injury with prostaglandin E1 reduces the risk of early hepatocellular carcinoma recurrence following liver transplantation.

AbstractBACKGROUND:
Surgical stress by hepatic ischaemia-reperfusion (I/R) is supposed to promote intra- and extrahepatic tumour recurrence. Treatment with prostaglandin E1 (PGE1) has been shown to attenuate hepatic I/R injury in liver transplant patients, but the potential anti-cancer effects have not been analysed.
AIM:
To evaluate the impact of PGE1 therapy on risk of hepatocellular carcinoma (HCC) recurrence in liver transplant patients.
METHODS:
A retrospective review of 106 liver transplant patients with HCC was conducted. Fifty-nine patients underwent early post-liver transplantation (LT) treatment with the stable PGE1 analogue alprostadil. Administration of alprostadil was correlated with outcome in uni- and multivariate analysis. Subgroup analysis focused on patients with HCC beyond the Milan criteria (Milan Out) on radiographic imaging.
RESULTS:
Three- and 5-year recurrence-free survival rates were 87.9% and 85.7% in the PGE1-group, but only 65.3% and 63.1% in the non-PGE1-population (P = 0.003). Multivariate Cox regression analysis identified absence of PGE1-treatment (HR = 11.42), along with presence of poor tumour grading (HR = 2.69) and microvascular tumour invasion (HR = 35.8) to be independently associated with early (within 12 months) HCC recurrence. In Milan Out-patients, only therapy with PGE1 (HR = 5.09) and well/moderate tumour differentiation (HR = 6.51) were independent promoters of recurrence-free survival.
CONCLUSIONS:
Treating hepatic ischaemia-reperfusion injury with alprostadil reduces the risk of early HCC recurrence following LT. In particular patients with HCC exceeding the Milan criteria seem to benefit from PGE1-treatment. The molecular mechanisms of the anti-tumour effects need to be further assessed.
AuthorsA Kornberg, U Witt, J Kornberg, H Friess, K Thrum
JournalAlimentary pharmacology & therapeutics (Aliment Pharmacol Ther) Vol. 42 Issue 9 Pg. 1101-10 (Nov 2015) ISSN: 1365-2036 [Electronic] England
PMID26282466 (Publication Type: Journal Article)
Copyright© 2015 John Wiley & Sons Ltd.
Chemical References
  • Alprostadil
Topics
  • Adult
  • Aged
  • Alprostadil (therapeutic use)
  • Carcinoma, Hepatocellular (diagnostic imaging, surgery)
  • Female
  • Humans
  • Liver Neoplasms (diagnostic imaging, surgery)
  • Liver Transplantation (adverse effects)
  • Male
  • Middle Aged
  • Neoplasm Recurrence, Local (complications, prevention & control)
  • Radiography
  • Reperfusion Injury (complications, drug therapy)
  • Retrospective Studies
  • Risk Factors
  • Survival Rate
  • Treatment Outcome

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