Association between the early high level of serum tacrolimus and recurrence of hepatocellular carcinoma in ABO-incompatible liver transplantation

BACKGROUND Clinical factors predicting graft survival(GS)after ABO-incompatible(ABOi)liver transplantation(LT),and differences between recipients with and without hepatocellular carcinoma(HCC)are unclear.AIM To analyze the impact of serial serum tacrolimus trough concentration in recipients with or without(HCC)in ABOi living-donor liver transplantation(LDLT).METHODS We analyzed a historical cohort of 89 recipients who underwent ABOi LDLT,including 47 patients with HCC.RESULTS The 1-,3-,5-,and 10-year GS rates were 85.9%,73.3%,71.4%,and 71.4%,respectively,and there were no significant differences between HCC and non-HCC recipients.In multivariate Coxregression analyses,tacrolimus trough concentrations below 5.4 ng/mL at 24 wk post-LT,in addition to the antibody-mediated rejection(AMR)were associated with poor-graft outcomes.In HCC patients,AMR[hazard ratio(HR)=63.20,P<0.01]and HCC recurrence(HR=20.72,P=0.01)were significantly associated with poor graft outcomes.HCCs outside Milan criteria,and tacrolimus concentrations at 4 wk post-LT>7.3 ng/mL were significant predictive factors for HCC recurrence.After propensity score matching,patients with high tacrolimus concentrations at 4 wk had significantly poor recurrence-free survival.CONCLUSION Elevated tacrolimus levels at 4 wk after ABOi LDLT have been found to correlate with HCC recurrence.Therefore,careful monitoring and control of tacrolimus levels are imperative in ABOi LT recipients with HCC.

A newly developed subcutaneous nodule 15 years after liver transplantation

A 79-year-old man,who had undergone liver transplantation(LT)15 years ago due to hepatocellular carcinoma(HCC)related to chronic hepatitis B,was referred for a newly developed 2 cm-sized mass on his left cheek(Figure 1A).Alpha-fetoprotein had been within normal range since LT,and the patient had been on 1 mg/day tacrolimus.Positron emission tomography-computed tomography documented a focal 18F-fluorodeoxyglucose uptake in skin lesion(Figure 1B).

Heterogenous responses to nivolumab in a single metastatic nodule in hepatocellular carcinoma: role of salvage surgery

A recent report demonstrated immune heterogeneityof hepatocellular carcinoma(HCC)(1).The objectiveresponse rates of sorafenib-treated global and Asian patientsby nivolumab,the monoclonal antibody to programmedcell death protein-1,were only 14%and 15%,respectively(2,3).