肝胰十二指肠器官簇移植术后的免疫抑制治疗

Immunosupressive regimen for combined 'en bloc' liver and pancreas transplantation

目的探讨肝胰十二指肠器官簇移植术后的免疫抑制治疗的合理用药方案。方法收集本中心共实施的10例肝胰十二指肠器官簇移植手术病例,其中5例为上腹部肿瘤伴腹腔多发转移病灶患者接受了肝脏、胰腺及上消化道全切除术后行器官簇移植,5例乙型肝炎后肝硬化失代偿期合并2型糖尿病患者予以单纯肝切除术后行器官簇移植。10例患者均采用巴利昔单抗+他克莫司+激素+霉酚酸酯四联免疫抑制方案,对患者的临床资料进行回顾性分析。结果 10例患者手术顺利,术后肝脏、胰腺及十二指肠功能恢复良好。5例肿瘤患者最长存活326d,3例死于多器官功能衰竭,2例死于肿瘤复发。5例肝硬化合并糖尿病患者除1例于术后4周死于移植物抗宿主病(GVHD)外,其余4例均存活,最长生存时间已超过21个月。随访期内及至患者死亡,10例患者均未发生排斥反应。结论采用巴利昔单抗+他克莫司+激素+霉酚酸酯四联免疫抑制方案可以有效预防肝胰十二指肠器官簇移植术后排斥反应的发生。

Objective To summarize the efficacy and safety of a quadruple immunosuppressive regimen used in combined ＇en bloc＇ liver and pancreas transplantation. Methods The medical records of 10 patients undergoing combined ＇en bloc＇ liver and pancreas transplantation, including 5 patients for gastrointestinal malignancy with liver metastasis, and 5 patients for end-stage liver cirrhosis complicated with insulin-dependent type 2 diabetes mellitus （T2DM）, were retrospectively reviewed. All recipients received a quadruple immunosuppressive regimen with anti-IL-2 receptor antibody （simulect） induction, tacrolimus, mycophenolate mofetil （MMF） and steroids. Results All recipients experienced a smooth recovery from the procedure, with normal or almost normal liver, pancreas and duodenum graft functions. All patients with malignancy indications died, of multiple organ failure in 3 cases and cancer recurrence in 2 cases. All patients with liver cirrhosis and T2DM survived, except that one patient died of graft- verse-host disease. No acute rejection episode was noticed during the follow up phase or until patient deaths. Conclusion The quadruple immunosuppressive regimen with simulect induction, tacrolimus, MMF and steroids, can effectively prevent acute rejection in combined ‘en bloc＇ liver and pancreas transplantation.