Sorafenib therapy for hepatocellular carcinoma prior to liver transplant is associated with increased complications after transplant


  • Conflicts of Interest
    The authors of this manuscript have potential conflicts of interest to disclose: Dr. Patrick Northup – multicenter institutional clinical trials funded through Bayer and Bristol Meyer-Squibb. All others have no conflicts of interest to disclose.

Patrick G. Northup MD, MHS, JPA and Lee Streets, MSB 2142, POB 800708, Division of Gastroenterology and Hepatology, University of Virginia, Charlottesville, VA 22908-0708 USA. Tel.: 434 243 2718; fax: 434 244 7529; e-mail:


This study compared post-transplant outcomes of patients with hepatocellular carcinoma (HCC) who took sorafenib prior to orthotopic liver transplantation (OLT) with those patients who were not treated with sorafenib. Thirty-three patients with HCC who were listed for liver transplantation were studied: 10 patients were treated with sorafenib prior to transplantation in an attempt to prevent progression of HCC while awaiting transplant. The remaining 23 patients were considered controls. The mean duration of sorafenib use was 19.2 (SD 25.2) weeks. Overall death rates were similar between the sorafenib group and control group (20% vs. 8.7%, respectively, P = 0.56). However, the patients in the sorafenib group had a higher incidence of acute cellular rejection following transplantation (67% vs. 22%, OR = 7.2, 95% CI 1.3–39.6, P = 0.04). The sorafenib group also had a higher rate of early biliary complications (67% vs. 17%, OR = 9.5, 1.6–55.0, P = 0.01). The use of sorafenib was found to be an independent predictor of post-transplant biliary complications (OR 12.6, 1.4–116.2, P = 0.03). Sorafenib administration prior to OLT appears to be associated with an increase in biliary complications and possibly in acute rejection following liver transplantation. Caution should be taken in this setting until larger studies are completed.