Liver Transplantation Clinical Trial
Official title:
Sirolimus-based Immunosuppression Treatment Regimen for Liver Transplantation: A Multicenter, Open-label, Randomized, Controlled Clinical Trial in Liver Transplant Recipients With Hepatocellular Carcinoma
This is a multicenter, open-label, randomized, controlled clinical trial, in order to compare sirolimus-based (tacrolimus-free) versus tacrolimus-based (sirolimus-free) immunosuppression regimen for Hepatocellular Carcinoma (HCC) patients after liver transplantation.
This 5-year study consisted of a 2-year enrolment period and a 3-year follow-up period.
Patients will be screened for eligibility prior to liver transplantation. Patients who have
undergone successful liver transplantation will be initiated on a tacrolimus-based regimen
that includes MMF and/or Steroids and enter the baseline period (between 3 and 7 days
post-transplantation). At 30 (± 5) days post-transplantation, patients who meet additional
randomization inclusion/exclusion criteria will be randomized into 2 groups of this study. In
the first group, patients will be maintained on a tacrolimus-based (sirolimus-free)
immunosuppression regimen. The second group will be treated with sirolimus-based
(tacrolimus-free) immunosuppression regimen. For patients in both groups, mycophenolic acid
prodrugs like mycophenolate mofetil (MMF) and steroids are initiated at the time of liver
transplantation according to local practice. Steroids reduction is encouraged by 3 months
post liver transplantation.
In the first year after randomization all patients will be followed up after month 1, 2, 3,
4, 5, 6, 8, 10 and 12. After that, patients are followed every 3 months. Tacrolimus and
sirolimus trough levels in patients of both groups will be tested and adjusted if need be at
each follow-up date to achieve the desired steady-state trough levels.
The primary endpoint is defined as HCC recurrence-free time interval between the date of
liver transplantation and the date of HCC recurrence or death; patients who are alive and
recurrence-free at the end of month 36 will be censored at the time of their last follow-up
date. HCC recurrence can be determined during the entire follow-up period.
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