索拉非尼引起移植肝肝功能异常1例

Impaired liver function induced by sorafenib in the patient with liver transplantation(a case report)

索拉非尼是近年来研制的一个口服多靶点抗肿瘤药物,它可显著延长晚期肝细胞癌患者生存时间,但其对肝功能是否有影响尚不清楚。给予索拉非尼治疗1例原发性肝细胞癌行肝移植术后11个月出现双肺转移的患者,服用索拉非尼3个月后肺内转移灶数目减少、体积缩小,但服药2周后患者转氨酶开始持续升高,此期间胆红素水平正常,无巨细胞病毒感染及乙肝活动证据。肝组织学检查见类似急性排斥反应表现。停用索拉非尼后转氨酶开始下降,3周后恢复正常。提示索拉非尼可抑制肺转移性肝癌的生长,但可能导致移植肝肝功能的损害。

Sorafenib is an oral multikinase inhibitor which prolong the survival time of patients with advanced hepatocellular carcinoma. However, it is unknown whether it causes damage to the liver. A patient with unresectable HCC on a cirrhotic liver received liver transplantation. After 11 months, the patient was found with multiple pulmonary tumor metastases and given with sorafenib. At three months after the administration of sorafenib, the size and the number of the metastatic tumors in two lungs decreased. The gradually elevated level of serum liver enzymes was found ever since the prescription. There was no evidence of infection of cytomegalovirus and activation of hepatitis B virus. The serum bilirubin level was within normal range, and liver biopsy discovered the histological presentation similar to acute rejection. The patient was asked to stop the administration of sorafenib and his liver enzymes returned to normal range 3 weeks later. It indicates that sorafenib inhibits the growth of metastatic hepatocellular carcinoma in the lung but may be toxic to the transplanted liver.