PMID- 36124430
OWN - NLM
STAT- MEDLINE
DCOM- 20221226
LR  - 20221226
IS  - 1399-0012 (Electronic)
IS  - 0902-0063 (Linking)
VI  - 36
IP  - 12
DP  - 2022 Dec
TI  - mTORi-based immunosuppression reduces HCC recurrence at the expense of increased 
      adverse side effects: A systematic review and meta-analysis.
PG  - e14823
LID - 10.1111/ctr.14823 [doi]
AB  - Sirolimus and everolimus are mammalian target of rapamycin inhibitors (mTORi) 
      that can reduce relapse rates following liver transplantation (LT) for 
      hepatocellular carcinoma (HCC). Herein, we performed a systematic review and 
      meta-analysis to investigate the efficacy of mTORi and calcineurin inhibitors 
      (CNI) in reducing HCC recurrence and survival adverse effects (AEs) in HCC 
      patients after LT. Systematic literature searches were conducted using MEDLINE, 
      EMBASE, and Cochrane Library databases up to October 2021. The primary outcomes 
      of interest were tumor recurrence rates and overall survival. The secondary 
      outcomes were the characterization and incidence of AEs. A total of 38 trials 
      involving 10,607 participants was included in the analysis. The incidence of 
      recurrence and overall mortality was significantly lower in the mTORi than in the 
      CNI group (relative ratio [RR]: .78, 95% confidence interval [CI]: .68-.89 and 
      RR: .76, 95% CI: .67-.86, respectively). The incidence of some AEs and 
      complications such as acne, anemia, abnormal healing, dyslipidemia, depression, 
      diarrhea, edema, headache/migraine, hypercholesterolemia, incisional hernia, 
      infection, leukopenia, mouth ulceration, pyrexia, proteinuria, pruritis, rash, 
      and thrombocytopenia were higher in the mTORi than in the CNI group. mTORi 
      reduced the recurrence incidence and overall 5-year mortality rate but increased 
      many other incidences of AEs compared with that by CNI. Therefore, clinicians 
      should be aware of the risks and benefits of mTORi use when managing patients 
      undergoing LT for HCC.
CI  - (c) 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
FAU - Zhang, Gongming
AU  - Zhang G
AUID- ORCID: 0000-0001-7354-2503
AD  - Beijing You'an Hospital, Capital Medical University, Beijing, China.
FAU - Duan, Binwei
AU  - Duan B
AD  - Beijing You'an Hospital, Capital Medical University, Beijing, China.
FAU - Li, Guangming
AU  - Li G
AD  - Beijing You'an Hospital, Capital Medical University, Beijing, China.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Research Support, Non-U.S. Gov't
PT  - Systematic Review
DEP - 20221202
PL  - Denmark
TA  - Clin Transplant
JT  - Clinical transplantation
JID - 8710240
RN  - 0 (Immunosuppressive Agents)
RN  - 0 (Calcineurin Inhibitors)
RN  - W36ZG6FT64 (Sirolimus)
SB  - IM
MH  - Humans
MH  - *Carcinoma, Hepatocellular/drug therapy/surgery
MH  - *Liver Neoplasms/drug therapy/surgery
MH  - Neoplasm Recurrence, Local
MH  - Immunosuppressive Agents/therapeutic use
MH  - Calcineurin Inhibitors/adverse effects
MH  - Sirolimus
MH  - Immunosuppression Therapy
OTO - NOTNLM
OT  - Sirolimus
OT  - adverse effects
OT  - everolimus
OT  - hepatocellular carcinoma
OT  - liver transplantation
OT  - mTORi
EDAT- 2022/09/21 06:00
MHDA- 2022/12/27 06:00
CRDT- 2022/09/20 03:02
PHST- 2022/08/13 00:00 [revised]
PHST- 2022/03/05 00:00 [received]
PHST- 2022/09/10 00:00 [accepted]
PHST- 2022/09/21 06:00 [pubmed]
PHST- 2022/12/27 06:00 [medline]
PHST- 2022/09/20 03:02 [entrez]
AID - 10.1111/ctr.14823 [doi]
PST - ppublish
SO  - Clin Transplant. 2022 Dec;36(12):e14823. doi: 10.1111/ctr.14823. Epub 2022 Dec 2.