终末期良性肝病患者肝移植后免疫抑制治疗单中心经验总结

Individual immunosuppressive protocol after liver transplantation in benign end-stage liver disease： a single-center experience of 645 cases

目的 总结单中心原发病为良性终末期肝病患者肝移植后免疫抑制剂的应用经验，探讨个体化治疗方案。方法回顾性分析单中心1400例肝移植中645例原发病为良性终末期肝病者的资料。2002年4月至2004年12月为第1阶段（共146例），受者均采用常规三联用药方案，即他克莫司（Tat）＋吗替麦考酚酯（MMF）＋甲泼尼龙（MP）；2005年1月至2007年12月为第2阶段（共273例），受者用药量较前减少；2008年1月至2010年8月为第3阶段（共226例），根据术前终末期肝病模型（MELD）评分及受者状况分为常规组和重症组，采用个体化免疫抑制方案。结果3个阶段中，MELD评分〈25分者的存活率分别为88．9％、94．2％和95．4％，MELD评分≥25分者的存活率分别为67．7％、73．4％和82．0％。3个阶段中MELD评分〈25分者排斥反应发生率的差异无统计学意义（尸〉0．05），MELD评分≥25分者第2阶段和第3阶段排斥反应发生率稍高于第1阶段（P〈0．05）。结论肝移植术后免疫抑制剂的应用可根据受者的具体情况进行个体化应用，有利于提高其存活率。

Objective To analyze the individual immunosuppressive protocol （IP） after liver transplantation （LT） in benign end-stage liver disease. Methods The clinical data of 645 patients with benign end-stage liver disease undergoing LT in our institute from April 2002 to Aug 2010 were analyzed retrospectively. 146 cases from Apr. 2002 to Dec. 2004 were in stage one, and triple therapy containing tacrolimus （Tac）, mycophenolate mofetil （MMF） and methylprednisolone （MP） was used; 273 cases from Jan. 2005 to Dec. 2007 were in stage two, and the less dose of immunosuppressant than stage one was used; 226 cases from Jan. 2008 to Aug. 2010 were in stage three, and they were divided into conventional group and severe patient group according to their preoperative model for endstage liver disease （MELD） score and patient condition, the individual IP was used. Results The overall survival rate of patients with MELD score 〈25 was 88. 9 %in stage one, 94. 2 % in stage two, and 95. 4 % in stage three; The overall survival rate of patients with MELD score≥25 was 67.7 % in stage one, 73.4 % in stage two, and 82. 0 %in stage three. The incidence of rejection in cases with MELD score 〈25 had no significant difference （P〉O. 05）. The incidence of rejection in cases with MELD score ≥25 in stage two and stage three was higher slightly than in stage one （P（ 0. 05）. Omdusion The IP after liver transplantation should be individualized according to recipient conditions, which can increase survival rate.