*Purpose: The optimal immunosuppression for liver transplant recipients (LTR) with hepatocellular carcinoma (HCC) is unknown. Basiliximab, an interleukin-2 receptor antagonist (IL-2RA), confers immunosuppression for LTR that require a delay in the initiation of calcineurin inhibitors (CNI). Basiliximab has been previously associated with early HCC recurrence, possibly due to inhibitory effects on regulatory T-cells involved in cancer surveillance. The objective of this study was to determine if peri-operative IL-2RA is associated with HCC recurrence post-transplant.

*Methods: All adult LTR with HCC between 2007 and 2014, at a single institution, were assessed. LTR who died within 90 days of transplant were excluded. Patients were stratified by receipt of IL-2RA for delayed CNI introduction. The primary outcome was recurrence-free survival (RFS) at 1 year between the two groups (no IL-2RA vs. IL-2RA). Secondary outcomes included RFS at 3 years and any recurrence.

*Results: A total of 248 LTR with pre-transplant HCC were included; 71 patients received peri-operative IL-2RA therapy. There were no differences in baseline characteristics. The median age at transplant was 60 years, 81% were male, and 53% had cirrhosis secondary to HCV. Pre-operative tumor characteristics (AFP, tumor size, tumor number and pre-MORAL score) as well as tumor characteristics on explant (tumor number, largest tumor size, vascular invasion, tumor grade, tumors outside MILAN criteria and combo-MORAL score) were similar between groups [Table 1]. RFS at 1 year and 3 years for no-IL2RA vs. IL2RA was 96.3% vs. 96.9% (p=0.47) and 91.1% vs. 92.9% (p=0.42), respectively. The incidence of HCC recurrence at anytime was 7.3% (n=13) in the no IL2-RA and 7% (n=5) in the IL2-RA group, p=0.93 [Figure 1] with a median follow-up time of 2.3 (1.1-3.7) years.

*Conclusions: There was no association between receipt of IL-2RA and early HCC recurrence.

« Back to 2019 American Transplant Congress