以西罗莫司为主的免疫抑制方案在肝癌肝移植受者中的应用

Sirolimus-based immunosuppression after liver transplantation for the patients with hepatocellular carcinoma

目的探讨肝癌肝移植受者术后采用以西罗莫司联合两剂激素为主的免疫抑制方案的安全性和有效性。方法2004年3月至2006年10月间，共为92例超出米兰标准的中晚期肝癌患者施行了肝移植，其中89例纳入研究。前54例患者采用以他克莫司为主的免疫抑制方案，后35例患者采用以西罗莫司为主的新免疫抑制方案。术后对两组受者均进行了随访。随访时检测受者的肝肾功能、血糖和血脂水平等生化指标，监测受者感染、急性排斥反应、肿瘤复发、存活率及药物副作用等表现，并对两组免疫抑制方案的效果进行了分析和比较。结果两组间1年肿瘤复发率、3个月内感染发生率、术后1个月高血糖发生率及术后1年肾功能损害和高脂血症发生率的比较，差异均有统计学意义（P〈0．05）；其它指标的比较，无显著性差异。结论肝癌肝移植受者采用以西罗莫司联合两剂激素为主的免疫抑制方案是安全和有效的。该方案在有效抑制排斥反应的同时可显著降低受者的肿瘤复发率，还可减少感染发生率、高血糖及肾功能损害，但增加了高脂血症发生率。

Objective To investigate the efficiency and safety of sirolimus-based and tow-dose steroid immunosuppression after liver transplantation for the patients with hepatocellular carcinoma （HCC）. Methods Ninety-two patients with HCC beyond Milan criteria underwent liver transplantation from March 2004 to October 2006 in our center, and 89 patients were taken into study. The former 54 patients received tacrolimus-baesd immunosuppression, and the subsequent 35 patients were subjected to sirolimus-based immunosuppression. Both of them were followed up after operation. The following indexes including liver and kidney function, blood glucose and cholesterol, HCC recurrence rate, infection rate, acute rejection rate, one-year survival rate and drug side effect were tested. Results There was significant difference between the two groups in one-year HCC recurrence rate, 3-month infection rate, one-month high glucose rate, one-year high cholesterol rate and renal function damage rate. Conclusions Sirolimus-based and tow-dose steroid immunosuppression is safe and effective for the patients with HCC. The protocol not only suppressed rejection actively, but also cut down HCC recurrence rate notably, and decreased infection rate, high glucose and renal function damage rate, though it increased high cholesterol rate.