暂停免疫抑制剂对肝移植术后严重感染疗效的探讨

Temporary withdrawal of immunosuppressant for the management of severe infection in liver transplantation recipients

目的 探讨肝移植术后并发严重感染暂时停用免疫抑制剂的安全性及有效性。方法 回顾性分析2003年10月至2006年11月期间因肝移植术后并发严重感染而14次停用免疫抑制剂的12名患者。结果 所有患者停用免疫抑制剂时间平均为14.57d（5～28d）。共6名患者死亡，死亡率为50.0%。排斥反应发生率为8.3%，经恢复使用原剂量的他克莫司后逆转。2005年9月前6名患者共8次停用免疫抑制剂（每次停用时间〈20d，为A组），死亡5例，死亡率为83.3%。2005年10月后6名患者采用较长时间停用免疫抑制剂（≥20d，为B组），死亡1例，死亡率为16.7%，明显低于A组（Х^2=0.08，P=0.04）。结论 暂时停用免疫抑制剂有助于控制肝移植术后严重感染，发生急性排斥反应后绝大部分患者均可以通过恢复使用免疫抑制剂逆转。

Objective To explore the safety and effectiveness of temporary withdrawal immunosuppressant for the management of severe infection after liver transplantation. Methods The clinical data of 12 cases who were suspended from immunosuppressant temporarily for a total of 14 episodes because of intractable systemic infection after orthotopic liver transplantation between October 2003 and November 2006 were analyzed retrospectively. Result The median suspension of immunosuppressant was 14. 57 days （ range 5- 28 days ）. The mortality rate was 50% （ six patients ）. During the period of suspension acute rejection developed in one patient （8.3%）, which was successfully managed by reinstitution of the previous dosage of FK506. Five out of six patients who were on shorter period of suspension （ 〈 20 d ） died in contrast to one death out of other six patient being on longer period of withdrawal （Х^2 = 0.08, P = 0. 04）. Conclusion Temporary withdrawal of immunosuppressant is helpful for controlling severe infection after liver transplantation and does not significantly increase the risk of acute rejection. In case of acute rejection reinstitution of FK506 is successful in most cases.