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Does mTORi base immunosuppression offer survival advantage after liver transplantation for hepatocellular carcinoma? Systematic review and meta-analysis of randomized controlled trials
1Department of Surgery, King Hussein Medical Centre, Amman, Jordan;
2Department of Surgery, Soroka Medical Centre, Beersheba, Israel;
3Department of surgery, Aminu Kano Teaching Hospital, Nigeria
Hepatology Forum 2023; 4(2): 82-88 DOI: 10.14744/hf.2022.2022.0049 PMCID: PMC10209974
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Recurrence is still a problem after liver transplant for hepatocellular carcinoma (HCC). We performed an updated systematic review and me-ta-analysis of randomized controlled trials comparing tumor recurrence of mammalian target of rapamycin inhibitors (mTORi) versus Calci-neurin inhibitor-based immunosuppression after liver transplantation for HCC. A systematic search was conducted in the following databas-es: MEDLINE, EMBASE, and Cochrane Central Register of Control Trials databases. The Medical Subject Headings used in the search in-cluded: “sirolimus,” “everolimus,” “mTORi,” “HCC,” “mTORi,” “he-patic transplantation” “randomized controlled trials,” and “liver trans-plantation (LT)”. Seven randomized controlled trials were included for meta-analysis. There were a total of 1,365 patients, with 712 of these patients receiving calcineurin inhibitors (CNIs) while 653 had received mTORi. Our meta-analysis revealed that patients that received mTO-Ri-based immunosuppression had superior recurrence-free survival (RFS) at 1 year and 3 years with a hazard ratio of 2.02 and 1.36, re-spectively. Meta-analysis also showed that within the first 3 years after LT for HCC, patients receiving CNIs-based immunosuppression have a higher recurrence than those receiving mTORi-based immunosuppres-sion. Our meta-analysis revealed that recipients of mTORi-based immu-nosuppression had a superior OS at 1 year and 3 years. mTORi-based immunosuppression is associated with decreased early recurrence and improved RFS and overall survival.