Abstract
Background: Hepatocellular Carcinoma (HCC) represents the fifth most common malignancy and the third cancer-related cause of death worldwide. Hepatitis B (HBV) and C (HCV) viral infections and alcohol abuse are the principal etiological factors for HCC. Liver transplantation (LT) is oncologically the preferable approach to HCC, as it can remove all the intrahepatic tumor foci, and also the oncogenic cirrhotic liver. The use of mTOR inhibitors (mTORi) for immunosuppression after LT for HCC has been proposed due to rapamycin antitumor activity. We decided to review the literature to clarify the oncological role of mTORi after liver transplantation for HCC, analyzing both present condition and future perspectives.Material and Methods: A systematic literature search was performed using PubMed, EMBASE, Scopus, and the Cochrane Library Central. The search was limited to studies in humans and to those reported in the English language in the period of time between January 2005 and December 2015.Results: The literature search yielded 93 articles; after duplicates were removed, 77 titles and abstracts were reviewed. Most relevant data and papers are herein reported and discussed.Conclusions: So far, the use of mTORi is encouraging in terms of oncological outcomes for patients underwent LT for HCC, both for prevention and treatment of HCC recurrence although definitive data are still awaited.
Highlights
Hepatocellular Carcinoma (HCC) is the third cancer-related cause of death worldwide and the fifth most common malignancy (Tejeda-Maldonado et al, 2015)
Those data reported by Chologitas and colleagues in their review are biased by the differences in risk factors for HCC recurrence: in particular, the percentage of patients treated with mammalian target of rapamycin (mTORi) that had been transplanted for HCC within Milan criteria (69%) was significantly lower than the one observed in patients treated with calcineurin inhibitors (CNIs) (74%) (p = 0.04) (Cholongitas et al, 2014b)
In the mTOR pathway there are two important components: mTOR complex 1 and mTOR complex 2 (Kawahara et al, 2011; Ashworth and Wu, 2014). m-TORC1 is activated by several signals, like Growth factors, various cytokines, co-stimulatory signals, Toll-like receptor (TLR) ligands, cellular energy levels, hypoxia, cellular stress, and DNA damage
Summary
Hepatocellular Carcinoma (HCC) is the third cancer-related cause of death worldwide and the fifth most common malignancy (Tejeda-Maldonado et al, 2015). HCC recurrence rate among patients transplanted for HCC within Milan criteria is lower in patients treated with mTORi, compared with those that received CNIs (p = 0.03). Patients transplanted for HCC within Milan criteria show lower HCC recurrence rate when compared with those transplanted for HCC outside Milan criteria, in a statistically significant fashion (Cholongitas et al, 2014b) Those data reported by Chologitas and colleagues in their review are biased by the differences in risk factors for HCC recurrence: in particular, the percentage of patients treated with mTORi that had been transplanted for HCC within Milan criteria (69%) was significantly lower than the one observed in patients treated with CNIs (74%) (p = 0.04) (Cholongitas et al, 2014b). We decided to review the literature to clarify the oncological role of mTORi after liver transplantation for HCC, analyzing both present condition and future perspectives
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
