Advanced Search
Switch to Simple Search
Clear
2 results
Filters
Sort By
Filters
Advanced Search
Switch to Simple Search
Clear
2 results
Download the following citations:
Email the following citations:
Print the following citations:
Long-Term Effects of Everolimus-Facilitated Tacrolimus Reduction in Living-Donor Liver Transplant Recipients with Hepatocellular Carcinoma
  • Sapisochin G
  • Lee WC
  • Joo DJ
  • Joh JW
  • Hata K
  • et al.
Ann Transplant. 2022 Nov 22;27:e937988 doi: 10.12659/AOT.937988.
CET Conclusion
Reviewer: Mr Keno Mentor, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This study analysed the long-term follow-up data of patients who underwent living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) and were enrolled in a previous RCT to receive combination everolimus/reduced tacrolimus or normal dose tacrolimus alone. The authors hypothesised that everolimus combined with reduced tacrolimus would reduce HCC recurrence and CNI-related renal dysfunction, and have similar immunosuppressive efficacy and safety. The original RCT followed the patients up for 12 months and reported similar efficacy and safety data between the 2 groups, with a reduced rate of HCC recurrence in the everolimus/reduced tacrolimus arm. This study followed these two groups of patients and analysed the same outcome measures at 5 years. Although all primary and secondary endpoints were numerically superior in the everolimus/reduced tacrolimus group, none of the differences reported achieved statistical significance. Furthermore, the all-cause 5-year overall survival was also not significantly different. This study essentially found similar outcomes to the original RCT and thus did not show compelling evidence of long-term benefit of the everolimus/reduced tacrolimus regimen in all patients who undergo LDLT. However, a sub-group analysis indicated that this regimen may benefit patients with a greater burden of HCC and who are transplanted outside of Milan criteria.
Aims: This follow-up study aimed to report the long term outcomes of a randomised controlled trial investigating the effects of everolimus (EVR) combined with reduced tacrolimus (rTAC) versus a standard TAC (sTAC) regimen in living-donor liver transplant recipients (LDLTRs) with hepatocellular carcinoma (HCC).
Interventions: Participants were randomly assigned to receive either EVR+rTAC or sTAC.
Participants: 117 HCC patients who underwent LDLT.
Outcomes: The primary outcome was HCC recurrence. The secondary efficacy outcomes included incidences of acute and chronic rejections, graft loss, death, ‘composite of drop-out’ [death, withdrawal of consent and lost to follow-up], changes in immunosuppressive regimen, malignancies other than HCC and change in renal function.
Follow Up: 60 months

BACKGROUND The study objective was to evaluate the effect of everolimus (EVR) in combination with reduced tacrolimus (rTAC) compared with a standard TAC (sTAC) regimen on hepatocellular carcinoma (HCC) recurrence in de novo living-donor liver transplantation recipients (LDLTRs) with primary HCC at liver transplantation through 5 years after transplantation. MATERIAL AND METHODS In this multicenter, non-interventional study, LDLTRs with primary HCC, who were previously randomized to either everolimus plus reduced tacrolimus (EVR+rTAC) or standard tacrolimus (sTAC), and who completed the 2-year core H2307 study, were followed up. Data were collected retrospectively (end of core to the start of follow-up study), and prospectively (during the 3-year follow-up study). RESULTS Of 117 LDLTRs with HCC at LT in the core H2307 study (EVR+rTAC, N=56; sTAC, N=61), 86 patients (EVR+rTAC, N=41; sTAC, N=45) entered the follow-up study. Overall HCC recurrence was lower but statistically non-significant in the EVR+rTAC group (3.6% vs 11.5% in sTAC; P=0.136) at 5 years after LT. There was no graft loss or chronic rejection. Acute rejection and death were comparable between treatment groups. Higher mean estimated glomerular filtration rate in the EVR+rTAC group (76.8 vs 65.8 mL/min/1.73 m² in sTAC) was maintained up to 5 years. Reported adverse events were numerically lower in the EVR+rTAC group (41.0% vs 53.5% sTAC) but not statistically significant. CONCLUSIONS Although statistically not significant, early EVR initiation reduced HCC recurrence, with comparable efficacy and safety, and better long-term renal function, than that of sTAC treatment.
Effect of administration of β-hydroxy-β-methyl butyrate-enriched formula after liver transplantation: A pilot randomized controlled trial
  • Kamo N
  • Kaido T
  • Uozumi R
  • Ito T
  • Yagi S
  • et al.
Nutrition. 2020 Nov-Dec;79-80:110871 doi: 10.1016/j.nut.2020.110871.
OBJECTIVE:

Most patients undergoing liver transplantation (LT) have decreased skeletal muscle mass, malnutrition, and decreased physical activity levels. These comorbidities may prevent early recovery after surgery. The aim of this study was to examine the effects of oral nutritional formula-enriched β-hydroxy-β-methyl-butyrate (HMB), a leucine metabolite that promotes muscle synthesis and suppresses proteolysis, on postoperative sarcopenia and other outcomes after adult-to-adult living donor LT (LDLT).

METHODS:

Thirty-three consecutive patients who underwent adult LDLT between March 2017 and October 2018 and who met inclusion criteria were randomly assigned in a 1:1 ratio to the HMB or control group. Patients in the HMB group received two packs of HMB-rich nutrients per day, which contained calcium-HMB (1500 mg), l-arginine (7000 mg), and l -glutamine (7000 mg) per pack orally or enterally from postoperative day 1 to 30 with postoperative rehabilitation. The primary endpoint was grip strength (GS) at 2 mo after LDLT. Secondary endpoints included GS at 1 mo after LDLT, skeletal muscle mass index (SMI) at 1 and 2 mo after LDLT, laboratory findings, incidence of postoperative bacteremia, and postoperative hospital length of stay (LOS).

RESULTS:

Twelve patients in the HMB group and 11 in the control group were included in the final analysis. GS at 1 and 2 mo and SMI values at 2 mo were significantly higher in the HMB group than in the control group (GS: both P < 0.001, SMI: P = 0.04). In the HMB group, white blood cell count 3 wk after LDLT was significantly lower (P = 0.005), and postoperative hospital LOS was significantly shorter (P = 0.028) compared with the control group. The incidence of postoperative bacteremia was lower in the HMB group.

CONCLUSIONS:

Postoperative administration of HMB-enriched formula with rehabilitation significantly increased GS at 1 and 2 mo and SMI at 2 mo and shortened postoperative hospital LOS after LDLT.