Rationale of personalized immunosuppressive medication for hepatocellular carcinoma patients after liver transplantation

Authors

  • Kan Chen,

    1. Bio-X Center, College of Life Sciences, Zhejiang Sci-Tech University, Hangzhou, China
    2. Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Center, Rotterdam, the Netherlands
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  • Kwan Man,

    1. Department of Surgery, Hong Kong University, Hong Kong, China
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  • Herold J. Metselaar,

    1. Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Center, Rotterdam, the Netherlands
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  • Harry L. A. Janssen,

    1. Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Center, Rotterdam, the Netherlands
    2. Division of Gastroenterology, University Health Network, Toronto, Canada
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  • Maikel P. Peppelenbosch,

    1. Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Center, Rotterdam, the Netherlands
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  • Qiuwei Pan

    Corresponding author
    1. Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Center, Rotterdam, the Netherlands
    • Address reprint requests to Qiuwei Pan, Ph.D., Department of Gastroenterology and Hepatology, Erasmus MC–University Medical Center, ‘s-Gravendijkwal 230, Room Na-617, NL-3015 CE Rotterdam, the Netherlands. Telephone: +31(0)107037502; FAX: +31(0)107032793; E-mail: q.pan@erasmusmc.nl

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  • The authors thank the International Liver Transplantation Society for an International Scholar Travel Award (to Qiuwei Pan), the Netherlands Organization for Scientific Research and the Netherlands Organization for Health Research and Development for their financial support of the Innovational Research Incentives Scheme Veni grant (916-13-032 to Qiuwei Pan), and the Science and Technology Department of Zhejiang Province Commonweal Technology Applied Research Projects (2012F82G2060018 to Kan Chen).

  • The authors have no conflicts of interest to declare.

Abstract

Liver transplantation is the only potentially curative treatment for hepatocellular carcinoma (HCC) that is not eligible for surgical resection. However, disease recurrence is the main challenge to the success of this treatment. Immunosuppressants that are universally used after transplantation to prevent graft rejection could potentially have a significant impact on HCC recurrence. Nevertheless, current research is exclusively focused on mammalian target of rapamycin inhibitors, which are thought to be the only class of immunosuppressive agents that can reduce HCC recurrence. In fact, substantial evidence from the bench to the bedside indicates that other classes of immunosuppressants may also exert diverse effects; for example, inosine monophosphate dehydrogenase inhibitors potentially have antitumor effects. In this article, we aim to provide a comprehensive overview of the potential effects of different types of immunosuppressants on HCC recurrence and their mechanisms of action from both experimental and clinical perspectives. To ultimately improve the outcomes of HCC patients after transplantation, we propose a concept and approaches for developing personalized immunosuppressive medication to be used either as immunosuppression maintenance or during the prevention/treatment of HCC recurrence. Liver Transpl 20:261-269, 2014. © 2013 AASLD.

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