原发性肝癌患者肝移植术后无激素免疫抑制方案的临床疗效

Clinical efficacy of steroid-free immunosuppressive regimen after fiver transplantation for patients with primary liver cancer

目的探讨原发性肝癌患者肝移植术后无激素免疫抑制方案的临床疗效。方法回顾性分析2010年1月至2017年1月112例原发性肝癌肝移植患者的临床资料。其中术后无激素组59例，激素组53例。术后无激素组采用的免疫抑制方案为：他克莫司＋吗替麦考酚酯片＋巴利昔单抗；激素组为：他克莫司＋吗替麦考酚酯片＋激素，激素于移植后第1天以后逐日减量，至移植后3个月停用。观察比较两组患者排斥反应、感染、肿瘤复发、乙肝病毒复发的发生率以及生存率。结果术后无激素组患者感染率为18．6％，明显低于激素组的37．7％（P〈0．05）。术后无激素组乙肝病毒复发率为5．1％，明显低于激素组的20．8％（P〈0．05）。无激素组超米兰标准原发性肝癌患者肝移植术后肿瘤复发率为70．0％，低于激素组的100％（P〈0．05）。术后无激素组患者1年、3年、5年生存率分别为96．4％、84．9％、69．3％，激素组分别为87．8％、64．9％、44．3％，差异有统计学意义（P〈0．05）。两组患者排斥反应发生率差异无统计学意义（P〉0．05）。结论肝癌肝移植患者术后应用无激素免疫抑制方案是安全可行的，不但不会增加急性排斥反应的发生率，而且可降低患者术后感染发生率和乙肝的复发率。特别是对于超米兰标准患者可以降低肿瘤复发风险，提高患者生存率。

Objective To study the clinical efficacy of steroid-free immunosuppressive therapy after liver transplantation in patients with primary liver cancer. Methods A retrospective study was conducted on the clinical data from January 2010 to October 2016 on 112 patients with primary liver cancer. There were 59 patients who had no steroid immunosuppressive regimen after operation, and 53 patients were in the steroid group. The immunosuppressive regimen used in the postoperative steroid-free group was tacrolimus ＋ myco- phenolate mofetil ＋ basiliximab. For the steroid group it was： tacrolimus ＋ mycophenolate moxibustion. The steroid was reduced daily in the first day after transplantation and was discontinued 3 months after trans- plantation. Follow-up observation of the differences between the two groups of patients on rejection, infec- tion, tumor recurrence, hepatitis B virus recurrence and survival were compared. Results The infection rate was 18.6% in the postoperative steroid-free group, which was significantly lower than that in the steroid group （37.7% , P 〈0.05 ）. The recurrence rate of hepatitis B virus in the postoperative steroid-free group was 5.1%, which was significantly lower than that in the steroid group （20.8% , P 〈0.05）. For patients who exceeded the Milan Criteria, the tumor recurrence rate was 70.0% in the postoperative steroid-free group, which was lower than the 100% in the steroid group （ P 〈 O. 05 ）. The 1-year, 3-year and 5-year sur- vival rates in the postoperative steroid-free group were 96.4%, 84.9% and 69.3%, respectively, which were better than the 87.8% , 64.9% and 44.3% （ P 〈 0.05 ） in the steroid group. The incidences of rejec- tion were not significantly different （ P 〉 0.05 ）. Conclusions The use of the steroid-free immunosuppres- sive regimen in patients with hepatocellular carcinoma after transplantation was safe and did not increase the incidence of acute rejection. The regimen reduced the incidences of postoperative infection and hepatitis B virus recurrence, especially in patients who exceeded the Milan Criteria. It reduced the risk of tumor recurrence and improved patient survival.