西罗莫司转换对超米兰标准肝癌肝移植患者肿瘤复发的影响

Effect of conversion to sirolimus-based immunosuppression on tumor recurrence after liver transplantation for hepatocellular carcinoma beyond the Standard Milan Criteria

目的研究西罗莫司为基础的免疫抑制方案对超米兰标准的肝癌肝移植患者生存率及肿瘤复发的影响。方法回顾分析2010年6月至2011年6月我院器官移植科22例超米兰标准肝癌肝移植患者的临床资料,其中11例肝移植术后免疫抑制剂采用他克莫司,11例肝移植术后免疫抑制剂由他克莫司转换为西罗莫司。比较两组急性排斥反应发生率、无瘤生存期、血常规、肝肾功能以及并发症等情况。结果对22例患者平均随访(12±3)个月(7～18个月),两组间急性排斥反应发生率无明显差异;西罗莫司组有4例复发,他克莫司组有8例复发,Kaplan-Meier无复发生存曲线显示转换为西罗莫司治疗的患者其肝癌无复发生存期高于他克莫司组(P<0.05)。西罗莫司组白细胞和血小板计数较他克莫司组降低,具有统计学意义(P<0.05)。3例因他克莫司肾毒性转换为西罗莫司治疗的患者肾功能均好转。西罗莫司治疗组患者有2例发生口腔溃疡,没有发生肝动脉栓塞等严重并发症。结论西罗莫司可有效用于超米兰标准肝癌肝移植患者,能够取得与他克莫司类似的抗排斥反应效果,同时明显降低肿瘤复发的风险。

Objective To investigate the effect of sirolimus（SRL）-based immunosuppression regimen on the survival and tumor recurrence in liver transplantation recipients with hepatocellular carcinoma beyond the standard Milan criteria.Methods We retrospectively analyzed 22 patients who received liver transplant in our hospital for HCC beyond the standard Milan criteria from June 2010 to June 2011.Eleven patients received tacrolimus for immunosuppression after liver transplant and the other 11 were converted from tacrolimus to SRL-based immunosuppression.The incidence rate of acute rejection,tumor-free survival period,blood routine,liver function and complications were compared between the two groups.Results The incidence rates of acute rejection were not significantly different between the two groups after a mean follow-up of（12±3） months（range,7-18 months）.Four patients in the SRL group and eight patients in tacrolimus group had HCC recurrence and metastasis.Kaplan-Meier recurrence-free survival curves demonstrated that SRL group had a significantly longer HCC recurrence-free survival than tacrolimus group（P〈0.05）.Compared with tacrolimus group,SRL group had significantly lower leukocyte and platelet counts（P〈0.05）.The tacrolimus-related nephrotoxicity was modestly improved in all the three patients after converted to SRL.Two patients suffered oral ulcers after conversion to SRL treatment and no severe complications such as arterial thrombosis were observed.Conclusion SRL can be effectively used for liver transplant recipients with hepatocellular carcinoma beyond the standard Milan criteria;it can achieve a similar anti-rejection effect to tacrolimus and can greatly reduce tumor recurrence.