Meta-analysis: recurrence and survival following the use of sirolimus in liver transplantation for hepatocellular carcinoma

Background The use of sirolimus (SRL)-based immunosuppression protocols have been reported to reduce recurrence rates following liver transplantation (LT) for hepatocellular carcinoma (HCC), although this is still a matter for debate. Aim To undertake a systematic review and meta-analysis of available literature on the usage of SRL as an immunosuppressive agent following LT for HCC, with a view to comparing cancer outcomes with the commonly used calcineurin inhibitors (CNIs). Methods Systematic review and meta-analysis carried out in line with the Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. Primary outcomes of interest were tumour recurrence rate and recurrence-free survival (RFS). Secondary outcomes were recurrence-related mortality and overall survival (OS). Results In all, 5 studies met the inclusion criteria (n = 74). The recurrence rate was lower in SRL group (4.912.9%) in comparison with CNIs (17.338.7%). The 1-, 3- and 5-year RFS was 9396%, 8286% and 7980% for SRL group, which was much better in comparison with the CNIs 7078%, 6465% and 5460% respectively. Similarly, 1-, 3- and 5-year OS was much better for SRL group (9495%, 85% and 80%) in comparison with CNIs (7983%, 66% and 5962%) respectively. Meta-analysis demonstrated lower recurrence (OR = 0.30, 95% CI = 0.160.55, P < 0.001), lower recurrence-related mortality (OR = 0.29, 5% CI = 0.120.70, P = 0.005) and lower overall mortality (OR = 0.35, 95% CI = 0.200.61, P < 0.001) for SRL group. Conclusion The review showed lower recurrence rate, longer recurrence-free survival and overall survival and lower recurrence-related mortality in sirolimus-treated patients in comparison with the calcineurin inhibitor-treated patients following liver transplantation for hepatocellular carcinoma.