Complications Associated With Pre-transplant Use of Sorafenib: Our Experience

Abstract

Introduction: With long wait times, managing patients with hepatocellular carcinoma (HCC) on the liver transplant (LT) waitlist is challenging and is constantly evolving. The potential of the multi-kinase inhibitor Sorafenib (SB), a cytostatic agent, in benefitting this patient population has been tempered by studies that have shown increased rate of post LT complications. We compared the rates of post LT complications between patients who received SB up to the day of LT and those who stopped SB before LT. Methods: We identified 13 patients who received SB prior to deceased donor LT at our center and did a retrospective review comparing post LT outcomes with respect to the timing of SB discontinuation pre LT. Results: 8 patients continued taking SB till the day of LT (group A), while SB was stopped in 5 (group B) due to side effects, 10-36 weeks prior to LT. Recipient age at LT, etiology of liver disease, waitlist time and MELD at the time of LT was similar in both groups. One patient in group B, died because of primary graft nonfunction and the remaining patients had 100% overall survival and tumor free survival at 1 year follow up. 5/5 in group B compared to 6/8 in group A had viable tumor on explant and the tumor stage were similar in both groups. One patient in group B had bile leak, which was managed successfully with endoscopic intervention. 3/8 patients in group A and none of the surviving patients in group B had biliary strictures requiring intervention. Pathologically confirmed moderate acute cellular rejection was seen in 1 group A patient, 7 months after LT and in none of the group B patients within the first year of LT. None of the patients had issues with wound healing. Conclusion: In our cohort of patients who receiving SB up to the day of LT, there was no increase in the rate of complications when compared with those who discontinued SB earlier. This lack of increase in post LT complications indicate that randomized controlled trials are warranted.