肝癌肝移植术后雷帕霉素与普乐可复为主免疫抑制治疗结果初探

Rapamycin and FK506 based immunosuppresive protocol for liver transplantation in hepatocellular carcinoma

目的探讨肝癌肝移植手术后使用雷帕霉素（rapamycin，RPM）与普乐可复为主的免疫抑制治疗是否有助于防止肝癌的复发与转移。方法2004年1月至2005年1月期间19例肝癌行肝移植病人（米兰标准6例，扩大米兰标准13例）随机选取其中10位病人作为治疗组（米兰标准2例，扩大米兰标准8例）手术后使用雷帕霉素与普乐可复为主免疫抑制治疗，9例（米兰标准1例，扩大米兰标准8例），采用普乐可复为主的肝癌肝移植病人作为对照组，比较两组肝癌病人的累计生存率和累计无瘤生存率，并长期随访了解其复发转移情况。结果肝癌病人肝移植术后生存时间及复发转移情况：至该文报告时，治疗组无死亡病例，仍存活10例，其中无瘤生存9例，带瘤生存1例；对照组死亡1例，仍存活8例，其中无瘤生存5例，带瘤生存3例。两组经检验差异有显著性。结论雷帕霉素可能有助于预防肝癌肝脏移植术后的转移与复发。

Objective To investigate whether rapamycin and FK506 based immunosuppresive protocol can avoid recurrence of hepatocellular carcinoma HCC） after liver transplantation. Methods Nineteen patients with HCC who underwent OLT from January 2004 to January 2005 were reviewed retrospectively. They were randomly divided into two groups： rapamycin group （Milan standard 2, extend Milan standard 8） and control （Milan standard 1, extend Milan standard 8）. The 19 patients were followed up for more than 17 months after transplantation. Results No death occurred in rapam ycin group. Nine patients had disease-free survival and 1 tumor recurrence. In the control group, 1 patient died, 5 had disease-free survival and 3 had tumor recurrence. Multivariate analysis showed that there were significant differences between the 2 groups. Conclusion Rapamycin may reduce the chance of recurrence after liver transplantation.