再次肝移植术后免疫抑制剂的应用分析

Application analysis of immunosuppressive agents after liver retransplantation

目的探讨再次肝移植术后免疫抑制剂的使用。方法回顾性分析54例再次肝移植患者的临床资料,免疫抑制剂方案为:①皮质激素+巴利昔单抗+他克莫司+吗替麦考酚酯四联免疫抑制方案;②皮质激素+巴利昔单抗+他克莫司三联免疫抑制方案;③巴利昔单抗+他克莫司+吗替麦考酚酯三联免疫抑制方案;④巴利昔单抗+他克莫司两联免疫抑制方案。分别计算各方案中发生感染或排斥反应的病例数及其预后转归。结果 54例成人再次肝移植患者,术后1年内死亡15例,其余39例患者长期存活。术后1年内急性排斥反应9例(16.7%),感染34例(63.0%)。其中方案1共31例患者,4例发生急性排斥反应(12.9%),20例发生术后感染(64.5%);方案2共15例患者,3例发生急性排斥反应(20.0%),10例发生术后感染(66.7%);方案3共1例患者,0例发生急性排斥反应(0%),1例发生术后感染(100%);方案4共7例患者,2例发生急性排斥反应(28.6%),3例发生术后感染(42.9%)。所有发生急性排斥反应的病例经增加他克莫司用量或甲强龙冲击治疗后症状均缓解,感染患者死亡12例,其余22例患者经对症抗感染治疗后好转。结论再次肝移植术后患者的免疫状态复杂,个体化免疫抑制治疗至关重要。

Objective To investigate the usage of immunosuppressive agents after liver retransplantation.Methods The clinical data of 54 adult liver retransplantation patients were retrospectively analyzed.According to the application of immunosuppressive regimen,the patients were divided into 4 groups:①corticosteroid+basiliximab+tacrolimus+mycophenolic acid(MPA)quadruple immunosuppressive regimen;②corticosteroid+basiliximab+tacrolimus triple immunosuppressive regimen;③basiliximab+tacrolimus+MPA triple immunosuppressive regimen;④basiliximab+tacrolimus two immunosuppressive regimen.Cases of acute rejection and infection were calculated andprognosis was recorded.Results Among 54 patients who underwent liver retransplantation,15 patients died in 1 year after surgery,and the remaining 39 patients survived for a long time.There were 9 cases(16.7%)with acute rejection and 34 cases(63.0%)with infection with in 1 year after operation.Among them,there were 31 patients in protocol 1,and 4 out of 31 had acute rejection(12.9%),20 cases had postoperative infections(64.5%).There were 15 patients in protocol 2,and 3 out of 15 had acute rejection(20.0%)and 10 cases had postoperative infections(66.7%);There were only 1 case in protocol 3,there was no acute convulsion(0%),1 case had postoperative infection(100%);And there were 7 patients in protocol 4,2 out of 7 had acute rejection(28.6%),3 cases occurred postoperative infection(42.9%).All the cases with acute rejection were relieved after increasing the dose of tacrolimus or the treatment with methylprednisolone.A total number of 12 infected patients died of infection,and the remaining 22 patients improved after anti-infective treatment.Conclusion The immune status of patients after liver retransplantation is complicated,and individualized immunosuppressive therapy is essential.