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. 2022 Nov 29;58(12):1755.
doi: 10.3390/medicina58121755.

A Reduction of Calcineurin Inhibitors May Improve Survival in Patients with De Novo Colorectal Cancer after Liver Transplantation

Ramin Raul Ossami Saidy  1 , Elisa Wegener  1 , Deniz Uluk  1 , Luca Dittrich  1 , Wenzel Schöning  1 , Georg Lurje  1 , Robert Öllinger  1 , Dominik Paul Modest  2 , Frank Tacke  3 , Oliver Haase  1 , Johann Pratschke  1 , Dennis Eurich  1
Affiliations

A Reduction of Calcineurin Inhibitors May Improve Survival in Patients with De Novo Colorectal Cancer after Liver Transplantation

Ramin Raul Ossami Saidy et al. Medicina (Kaunas). .

Abstract

Background and Objectives: After liver transplantation (LT), long-term immunosuppression (IS) is essential. IS is associated with de novo malignancies, and the incidence of colorectal cancer (CRC) is increased in LT patients. We assessed course of disease in patients with de novo CRC after LT with focus of IS and impact on survival in a retrospective, single-center study. Materials and Methods: All patients diagnosed with CRC after LT between 1988 and 2019 were included. The management of IS regimen following diagnosis and the oncological treatment approach were analyzed: Kaplan−Meier analysis as well as univariate and multivariate analysis were performed. Results: A total of 33 out of 2744 patients were diagnosed with CRC after LT. Two groups were identified: patients with restrictive IS management undergoing dose reduction (RIM group, n = 20) and those with unaltered regimen (maintenance group, n = 13). The groups did not differ in clinical and oncological characteristics. Statistically significant improved survival was found in Kaplan−Meier analysis for patients in the RIM group with 83.46 (8.4−193.1) months in RIM and 24.8 (0.5−298.9) months in the maintenance group (log rank = 0.02) and showed a trend in multivariate cox regression (p = 0.054, HR = 14.3, CI = 0.96−213.67). Conclusions: Immunosuppressive therapy should be reduced further in patients suffering from CRC after LT in an individualized manner to enable optimal oncological therapy and enable improved survival.

Keywords: colorectal carcinoma; de novo malignancy; immunosuppression; liver transplantation.

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Conflict of interest statement

All authors declare no conflicts of interest related to the presented work.

Figures

Figure 1
Figure 1
Impact of RIM on survival after diagnosis of de novo CRC after LT. RIM—restrictive immunosuppressive management.
Figure 2
Figure 2
Subgroup analysis of survival of patients with and without RIM dependent on lymph node manifestation or distant metastases at time of diagnosis of CRC after LT. Kaplan-Meier analysis of patients without tumor manifestations in lymph nodes (a) or distant metastases (b) as well as patients with histological proven tumor manifestation in local lymph nodes (c) or distant metastases (d) at initial diagnosis of CRC seem to profit from a additional restrictive immunosuppressive regimen upon diagnosis but no statistical significant difference was reached. RIM—restrictive immunosuppressive management.
Figure 2
Figure 2
Subgroup analysis of survival of patients with and without RIM dependent on lymph node manifestation or distant metastases at time of diagnosis of CRC after LT. Kaplan-Meier analysis of patients without tumor manifestations in lymph nodes (a) or distant metastases (b) as well as patients with histological proven tumor manifestation in local lymph nodes (c) or distant metastases (d) at initial diagnosis of CRC seem to profit from a additional restrictive immunosuppressive regimen upon diagnosis but no statistical significant difference was reached. RIM—restrictive immunosuppressive management.
Figure 3
Figure 3
Impact of RIM dependent on tumor stage according to UICC.
Figure 4
Figure 4
Dependence of survival from tacrolimus trough level after de novo CRC.
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