肝移植术后激素24小时撤离的安全性

Safety of immunosuppressive regimen with steroids twenty-four hours withdrawal in liver transplantation

目的探讨肝移植术后激素24小时撤离的安全性及可行性。方法 76例成人肝移植患者随机分为激素3个月(3m)撤离组(40例)和24h撤离组(36例),所有患者随访至2009年12月,前瞻性比较两组患者术后生存、感染、急性排斥反应、切口愈合不良、肝炎和肝癌复发、新发糖尿病、高脂血症及高血压的发生情况。结果两组间患者术后生存、急性排斥反应、高脂血症、乙肝复发及肝癌复发无明显区别,24h撤离组的术后切口愈合不良、高血压、感染及新发糖尿病发生率明显低于3m撤离组。结论肝移植术后采用IL-2单克隆抗体诱导下的以FK506为基础的免疫抑制方案时,激素24h撤离是安全的,而且可以明显减少激素相关的副作用。

Objective To investigate the safety and feasibility of immunosuppressive regimen with steroids 24 hours withdrawal in liver transplantation. Methods Seventy-six patients in line with the selecting criteria were divided into two groups according to the withdrawal of steroids： 40 cases in 3 months withdrawal group and the other 36 cases in 24 hours withdrawal group. The difference of recipients＇ survival, infection, acute rejection, wound healing, recurrence of hepatitis B virus （HBV） and hepatocellular carcinoma （HCC）, new on-set of diabetes, hyperlipoidemia and hypertension between the two groups were compared. Results The difference of recipients＇ survival, acute rejection including steroids resistant acute rejection, recurrence of HBV and HCC, hyperlipoidemia between the two groups were not significant. Incidence of infection, new on-set diabetes, wound unhealing and hypertension in 24 h withdrawal group was significantly lower than that in 3 months withdrawal group. Conclusion Steroids 24 hours withdrawal immunosuppressive strategy is safe and feasible in liver transplantation field, it will significantly reduce the steroids related complications.