Liu D, Youssef MM, Grace JA, Sinclair M. Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care. World J Hepatol 2024; 16(4): 650-660 [PMID: 38689747 DOI: 10.4254/wjh.v16.i4.650]
Corresponding Author of This Article
Dorothy Liu, B-BMed, MD, FRACP, Doctor, Department of Gastroenterology, Austin Health, 145 Studley Road, Heidelberg, Melbourne 3084, Victoria, Australia. dorothy.liu2@austin.org.au
Research Domain of This Article
Transplantation
Article-Type of This Article
Systematic Reviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Apr 27, 2024; 16(4): 650-660 Published online Apr 27, 2024. doi: 10.4254/wjh.v16.i4.650
Relative carcinogenicity of tacrolimus vs mycophenolate after solid organ transplantation and its implications for liver transplant care
Dorothy Liu, Mark M Youssef, Josephine A Grace, Marie Sinclair
Dorothy Liu, Josephine A Grace, Marie Sinclair, Department of Gastroenterology, Austin Health, Melbourne 3084, Victoria, Australia
Dorothy Liu, Marie Sinclair, Victorian Liver Transplant Unit, Austin Health, Melbourne 3084, Victoria, Australia
Dorothy Liu, Mark M Youssef, Josephine A Grace, Marie Sinclair, Department of Medicine, University of Melbourne, Melbourne 3084, Victoria, Australia
Author contributions: Liu D was involved in data interpretation, drafting of the original and revised manuscripts, and prepared some of the figures and tables; Youssef MM performed data acquisition and prepared some of the figures and tables; Sinclair M was responsible for the study design; Grace JA and Sinclair M were involved in data interpretation and critical revision of the manuscript; and all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors have no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: December 16, 2023 Peer-review started: December 16, 2023 First decision: January 17, 2024 Revised: January 30, 2024 Accepted: March 19, 2024 Article in press: March 19, 2024 Published online: April 27, 2024 Processing time: 130 Days and 5.5 Hours
ARTICLE HIGHLIGHTS
Research background
Many liver transplant (LT) recipients are able to be maintained on long-term immunosuppressive monotherapy, most commonly with either tacrolimus or mycophenolate. In experimental studies, tacrolimus is associated with increased carcinogenicity, whereas mycophenolic acid (MPA) may have anti-neoplastic properties. However, there is minimal clinical data comparing the relative carcinogenicity of tacrolimus and MPA in LT or other solid organ transplant recipients.
Research motivation
Post-transplant malignancy (PTM) is a leading cause of late mortality in LT recipients. Thus, a clinically relevant difference in the carcinogenic risk profile between tacrolimus and MPA will affect the choice of immunosuppressive agent used as maintenance monotherapy in LT patients.
Research objectives
To determine the relative carcinogenicity of tacrolimus and MPA in solid organ transplantation.
Research methods
A systematic review was conducted using PRISMA guidelines with relevant articles published between 1st January 2002 to 11th August 2022 retrieved from MEDLINE and Embase databases for review.
Research results
A total of 6 studies were included in this systematic review, which did not demonstrate a clear difference between tacrolimus and MPA in the development of de novo PTM following solid organ transplantation.
Research conclusions
The relative carcinogenicity of tacrolimus and MPA, and its clinical relevance in solid organ transplantation, remains unclear.
Research perspectives
This review highlights the need for further large, population-based prospective studies to further assess the carcinogenic profiles of tacrolimus and MPA, to assist physicians in the choice of immunosuppressive agent to use as maintenance monotherapy in LT patients.
