Impact of sirolimus on HCV progression in liver transplant recipients

American Journal of Transplantation, 2011. McKenna et al. 

Sirolimus is used in post-transplant immunosuppression. Since it is not part of the calcineurin inhibitor (CNI) family like tacrolimus and cyclosporin, it is often used in cases of CNI nephrotoxicity or intolerance. Furthermore, it is thought to have properties that delay progression of fibrosis in HCV and prevent neoangiogenesis in cases of hepatocellular carcinoma.

This article followed two arms of liver transplant recipients: control arm with a cacineurin inhibitor (n=282) and a study arm (n=173) with early sirolimus initiation. It is readily apparent that the two arms are not equal from the outset: the control arm had a significantly higher MELD score (ie. sicker patient) and far fewer patients with hepatocellular carcinoma.

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