{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T04:53:39Z","timestamp":1784091219402,"version":"3.55.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,1,17]],"date-time":"2022-01-17T00:00:00Z","timestamp":1642377600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>The effects of mammalian target of rapamycin (mTOR) inhibitors (sirolimus [SRL] and everolimus [EVL]) on survival in liver transplantation (LT) recipients with hepatocellular carcinoma (HCC) remain the subject of intense research. Therefore, we performed this systematic review and meta\u2010analysis to investigate the potential survival benefits of mTOR inhibitors (mTORis). Embase, PubMed, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched for all randomized controlled trials (RCTs) and cohort studies investigating effects of SRL or EVL on LT recipients for HCC. The primary outcomes were 1\u2010, 2\u2010, 3\u2010, and 5\u2010year overall survival (OS), and the secondary outcomes were 1\u2010, 2\u2010, and 3\u2010year recurrence\u2010free survival (RFS) and adverse effects. Pooled relative risks (RRs) with 95% confidence interval (CI) were calculated by a fixed or random effects model with Mantel\u2010Haenszel weighting. Subgroup analyses were performed according to crucial clinical characteristics. We also conducted sensitivity analyses to assess the reliability of our findings. A total of 17 studies were included. OS was improved in both RCTs (1 year: RR, 1.04; 95% CI, 1.00\u20101.08; 2 years: RR, 1.09; 95% CI, 1.02\u20101.16; 3 years: RR, 1.13; 95% CI, 1.04\u20101.24; 5 years: RR, 1.13; 95% CI, 1.02\u20101.26) and cohort studies (1 year: RR, 1.13; 95% CI, 1.06\u20101.20; 2 years: RR, 1.24; 95% CI, 1.16\u20101.32; 3 years: RR, 1.24; 95% CI, 1.15\u20101.34; 5 years: RR, 1.17; 95% CI, 1.10\u20101.24), with a lower risk of renal toxicity (RR, 0.75; 95% CI, 0.60 to 0.93). The 1\u2010, 2\u2010, and 3\u2010year RFS were also improved. Current evidence indicates that SRL\u2010 or EVL\u2010based immunosuppression improves OS and RFS with a lower risk of renal toxicity compared with mTORi\u2010free immunosuppression. Nevertheless, results must be interpreted with caution.<\/jats:p>","DOI":"10.1002\/lt.26387","type":"journal-article","created":{"date-parts":[[2021,12,16]],"date-time":"2021-12-16T12:38:58Z","timestamp":1639658338000},"page":"1063-1077","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":44,"title":["Sirolimus or Everolimus Improves Survival After Liver Transplantation for Hepatocellular Carcinoma: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1097","volume":"28","author":[{"given":"Xiangyu","family":"Yan","sequence":"first","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songhan","family":"Huang","sequence":"additional","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ziwen","family":"Lu","sequence":"additional","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feiyu","family":"Li","sequence":"additional","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liyong","family":"Jiang","sequence":"additional","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Jiang","sequence":"additional","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Liu","sequence":"additional","affiliation":[{"name":"Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"},{"name":"Department of Hepatobiliary Surgery and Center of Organ Transplantation, Shandong Provincial Hospital, Cheeloo College of Medicine,Shandong University,Jinan,Shandong Province,China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,1,17]]},"reference":[{"key":"lt26387-bib-0001-20250824","first-page":"237","article-title":"Hepatocellular carcinoma: current management and recent advances","volume":"7","year":"2008","journal-title":"Hepatobiliary Pancreat Dis Int"},{"key":"lt26387-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"753","DOI":"10.1016\/j.bpg.2014.08.007","article-title":"Hepatocellular carcinoma epidemiology","volume":"28","year":"2014","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"lt26387-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"1195","DOI":"10.1002\/lt.20239","article-title":"Liver transplantation for hepatocellular carcinoma: further considerations on selection criteria","volume":"10","year":"2004","journal-title":"Liver 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