Meta-analysis: recurrence and survival following the use of sirolimus in liver transplantation for hepatocellular carcinoma


  • As part of AP&T's peer-review process, a technical check of this meta-analysis was performed by Dr G. Eslick.

Correspondence to:

Prof. N. D. Heaton, Institute of Liver Studies, King's College Hospital, Denmark Hill, London SE5 9RS, UK.




The use of sirolimus (SRL)-based immunosuppression protocols have been reported to reduce recurrence rates following liver transplantation (LT) for hepatocellular carcinoma (HCC), although this is still a matter for debate.


To undertake a systematic review and meta-analysis of available literature on the usage of SRL as an immunosuppressive agent following LT for HCC, with a view to comparing cancer outcomes with the commonly used calcineurin inhibitors (CNIs).


Systematic review and meta-analysis carried out in line with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Primary outcomes of interest were tumour recurrence rate and recurrence-free survival (RFS). Secondary outcomes were recurrence-related mortality and overall survival (OS).


In all, 5 studies met the inclusion criteria (n = 474). The recurrence rate was lower in SRL group (4.9–12.9%) in comparison with CNIs (17.3–38.7%). The 1-, 3- and 5-year RFS was 93–96%, 82–86% and 79–80% for SRL group, which was much better in comparison with the CNIs 70–78%, 64–65% and 54–60% respectively. Similarly, 1-, 3- and 5-year OS was much better for SRL group (94–95%, 85% and 80%) in comparison with CNIs (79–83%, 66% and 59–62%) respectively. Meta-analysis demonstrated lower recurrence (OR = 0.30, 95% CI = 0.16–0.55, P < 0.001), lower recurrence-related mortality (OR = 0.29, 95% CI = 0.12–0.70, P = 0.005) and lower overall mortality (OR = 0.35, 95% CI = 0.20–0.61, P < 0.001) for SRL group.


The review showed lower recurrence rate, longer recurrence-free survival and overall survival and lower recurrence-related mortality in sirolimus-treated patients in comparison with the calcineurin inhibitor-treated patients following liver transplantation for hepatocellular carcinoma.