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Outcome of adjuvant chemotherapy following liver transplantation for HCC
36
Indian Journal of Transplantation
Efficacy And Safety Of Sirolimus In Chronic Allograft Nephropathy: Single Centre Experience Mavani S, Gohel K, Hegde U, Gang S, Rajapurkar M, Acharya V, Dept of Nephrology, MPUH, Nadiad.
Background : Chronic allograft nephropathy (CAN) represents the main cause of renal allograft loss after one year of transplantation. Calcinurin inhibitors (CNI) use is associated with increased graft expression of profibrotic cytokines, whereas sirolimus inhibits fibroblast proliferation.
Aim of the study : The aim of this retrospective study was to asses the outcome of patients switched from CNI to sirolimus for biopsy proven CAN.
Method : 15 patients who underwent live renal allograft between 2002 to 2007 were studied retrospectively. Sirolimus trough level was maintained at 6-8 ng / ml.
Results : After average duration of 1 year post transplant sirolimus was started. Estimated GFR at starting of therapy was: 52. 9 + 16. 6 ml/min/1. 73 m2. After 6 months it was 51. 02+ 8. 796 ml/min/1. 73 m2(p = 0. 43 NS), after 1 year 58. 02+ 8. 63 ml/min/1. 73 m2 ( p=0. 09 NS) , after 2 years 63. 49+ 14. 19 ml/min/1. 73 m2( p= 0. 02 S). Rise in s. Triglyceride and Total cholesterol was not significant [(158. 2+21 vs 171+32. 5 p = 0. 11 NS). and (171+42. 2 vs 192. 1+51. 8 p = 12 NS). Respectively. ] Fall in hemoglobin and platelet counts was not noted [(11. 8vs 12. 1 gm %). and (250 × 103/ μL vs 230× 103/ μL ) respectively. ] There was no significant increase in proteinuria [Urine protein creat ratio (0. 5 vs 0. 6 )]
Conclusion : In short term switching from CNI to sirolimus is safe and effective.
Copyright © 2008 by The Indian Society of Organ Transplantation
Indian J Transplant 2008; 2: 32-50
Outcome of adjuvant chemotherapy following liver transplantation for HCC S. Bhattacharjya, D. Chattopadhyay, HL Reeves, S Stewart, DM Manas. Department of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
The adoption of selective criteria has resulted in improved survival in transplantation for cirrhosis complicated by hepatocellular cancers (HCC). Early recurrent disease is a frequent cause for treatment failure. The aim of this study was to assess the effects of adjuvant chemotherapy on disease recurrence and overall survival after liver transplantation.
Patients and Methods : The study was performed between 1993 to 1996. Patients with cirrhosis complicated by HCC were considered for orthotopic liver transplantation (OLT) if they met the Milan criteria. Doxorubicin at a dose of 20mg / m2 was administered in the anhepatic phase as well as postoperatively at weekly intervals 4 weeks after OLT to a cumulative dose of 200mg/ m2. The patients were followed with serial alpha fetoprotein (AFP) assays and contrast CT of the chest abdomen and pelvis at 6 monthly intervals for the first year and annually thereafter. Recurrence was considered to be present if detected on imaging or a serum AFP above normal. Kaplan Meier curves were used to assess overall and disease free survival.
Results : 30 patients underwent OLT for cirrhosis complicated by HCC. All fulfilled the Milan criteria and received doxorubicin during the anhepatic phase. In the immediate post-transplant period, there were 2 deaths unrelated to HCC and 2 patients needed urgent re-transplantation for primary non-function or hepatic artery thrombosis. Only 24 patients progressed to systemic adjuvant chemotherapy 4 weeks after OLT. 3 patients developed recurrent disease. The overall five-year survival and disease free survival were 83. 1% and 77% respectively.
Conclusions : The results of this study suggest a survival benefit with adjuvant chemotherapy following OLT for cirrhosis complicated by HCC.
Indian Journal of Transplantation
Efficacy And Safety Of Sirolimus In Chronic Allograft Nephropathy: Single Centre Experience Mavani S, Gohel K, Hegde U, Gang S, Rajapurkar M, Acharya V, Dept of Nephrology, MPUH, Nadiad.
Background : Chronic allograft nephropathy (CAN) represents the main cause of renal allograft loss after one year of transplantation. Calcinurin inhibitors (CNI) use is associated with increased graft expression of profibrotic cytokines, whereas sirolimus inhibits fibroblast proliferation.
Aim of the study : The aim of this retrospective study was to asses the outcome of patients switched from CNI to sirolimus for biopsy proven CAN.
Method : 15 patients who underwent live renal allograft between 2002 to 2007 were studied retrospectively. Sirolimus trough level was maintained at 6-8 ng / ml.
Results : After average duration of 1 year post transplant sirolimus was started. Estimated GFR at starting of therapy was: 52. 9 + 16. 6 ml/min/1. 73 m2. After 6 months it was 51. 02+ 8. 796 ml/min/1. 73 m2(p = 0. 43 NS), after 1 year 58. 02+ 8. 63 ml/min/1. 73 m2 ( p=0. 09 NS) , after 2 years 63. 49+ 14. 19 ml/min/1. 73 m2( p= 0. 02 S). Rise in s. Triglyceride and Total cholesterol was not significant [(158. 2+21 vs 171+32. 5 p = 0. 11 NS). and (171+42. 2 vs 192. 1+51. 8 p = 12 NS). Respectively. ] Fall in hemoglobin and platelet counts was not noted [(11. 8vs 12. 1 gm %). and (250 × 103/ μL vs 230× 103/ μL ) respectively. ] There was no significant increase in proteinuria [Urine protein creat ratio (0. 5 vs 0. 6 )]
Conclusion : In short term switching from CNI to sirolimus is safe and effective.
Copyright © 2008 by The Indian Society of Organ Transplantation
Indian J Transplant 2008; 2: 32-50
Outcome of adjuvant chemotherapy following liver transplantation for HCC S. Bhattacharjya, D. Chattopadhyay, HL Reeves, S Stewart, DM Manas. Department of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK.
The adoption of selective criteria has resulted in improved survival in transplantation for cirrhosis complicated by hepatocellular cancers (HCC). Early recurrent disease is a frequent cause for treatment failure. The aim of this study was to assess the effects of adjuvant chemotherapy on disease recurrence and overall survival after liver transplantation.
Patients and Methods : The study was performed between 1993 to 1996. Patients with cirrhosis complicated by HCC were considered for orthotopic liver transplantation (OLT) if they met the Milan criteria. Doxorubicin at a dose of 20mg / m2 was administered in the anhepatic phase as well as postoperatively at weekly intervals 4 weeks after OLT to a cumulative dose of 200mg/ m2. The patients were followed with serial alpha fetoprotein (AFP) assays and contrast CT of the chest abdomen and pelvis at 6 monthly intervals for the first year and annually thereafter. Recurrence was considered to be present if detected on imaging or a serum AFP above normal. Kaplan Meier curves were used to assess overall and disease free survival.
Results : 30 patients underwent OLT for cirrhosis complicated by HCC. All fulfilled the Milan criteria and received doxorubicin during the anhepatic phase. In the immediate post-transplant period, there were 2 deaths unrelated to HCC and 2 patients needed urgent re-transplantation for primary non-function or hepatic artery thrombosis. Only 24 patients progressed to systemic adjuvant chemotherapy 4 weeks after OLT. 3 patients developed recurrent disease. The overall five-year survival and disease free survival were 83. 1% and 77% respectively.
Conclusions : The results of this study suggest a survival benefit with adjuvant chemotherapy following OLT for cirrhosis complicated by HCC.