Introduction: A liver transplantation (LT) is a first line therapeutic choice for patients with hepatocellular carcinoma (HCC). Mammalian Target of Rapamycin (mTOR) inhibitors act as immunosuppressant and indicated against HCC recurrence in LT patients. The efficacy of mTOR inhibitors in preventing HCC recurrence remains contentious.
Methods: We retrospectively enrolled 45 patients (average age 50, M/F:29/16) who had a history of HCC at the time of LT operation at a single center (2011-2023) and divided into a mTOR and non-mTOR groups. Initial Alfa-fetoprotein (AFP), Protein induced by vitamin K absence-II (PIVKA-II) levels, contrast-enhanced abdominal computer-assisted tomography (CT) scans were compared to most recent results, explant histology was also assessed for HCC extent. Decision to transplant was made based on Milan criteria. Student t-test was used to determine statistical significance (p<0.05).
Results: In the mTOR group (n=23, average age 52.7) there were 2 confirmed HCC recurrences with elevated markers and positive CT scans. In the non-mTOR group (n=22, average age 47.4) there was 1 confirmed case of HCC. A recurrence rate of 6.67% was recorded overall, 8.7% and 4.55% for mTOR and non-mTOR (p=0.28), respectively. All three recurrences were detected within 24 months of the operation. For recurrent HCCs, the average levels of PIVKA-II and AFP were 27010mAU/ml and 2842.7ng/ml, respectively. There was no difference in number and mode of pre-LT bridging therapies (TACE or RFA) with regards to recurrence. There were two cases of elevated PIVKA-II without a radiologic confirmation.
Conclusion: Adherence to the Milan criteria and application of pre-LT bridging therapies will keep the recurrence rate below 10%. Any possible recurrence will be diagnosed within 24 months of LT. Administration of mTOR inhibitors can be stopped after 2 years as part of the physician-guided minimization of immune suppression regimen.