肝移植术后撤除免疫抑制剂的回顾性分析

Retrospective analysis of immunosuppression drug withdrawal after liver transplantation

目的:分析肝移植病人术后完全撤除免疫抑制剂的临床资料。方法:回顾性分析自2013年1月至2020年6月本中心撤除免疫抑制剂的15例肝移植病人临床资料。结果:11例因严重免疫抑制剂不良反应而被动撤药,平均撤药时间(10.4±6.2)个月。2例发生急性排斥反应。撤药成功率81.8%。主动撤药的4例病人平均撤药时间(28.8±30.3)个月,全部撤药成功(100%),其中1例已完全撤药74个月。主动撤药组与被动撤药组相比,在性别、年龄、体质量指数、使用单抗诱导、撤药时肝移植术后时间、合并症(糖尿病、高血脂、高血压)、撤药时间以及撤药成功率的差异无统计学意义(P>0.05)。撤药成功组撤药时肝移植术后时间明显长于撤药失败组(P<0.05)。结论:长期生存的肝移植病人在医师指导下可完全撤除免疫抑制剂,但应严密随访。

Objective To analyze the clinical data of patients with immunosuppression drug withdrawal after liver transplantation.Methods The clinical data of 15 patients with immunosuppression drug withdrawal after liver transplantation in our center from January 2013 to June 2020 were analyzed retrospectively.Results Eleven patients had immunosuppression withdrawal passively with time(10.4±6.2)months because of severe adverse effects.Two cases had acute rejection and success rate was 81.8%.The withdrawal time of 4 patients with active immunosuppression withdrawal was(28.8±30.3)months,and withdrawal was all successful(100%).One case had complete immunosuppression withdrawn for 74 months.There were no statistically significant differences in terms of sex,age,body mass index,induction of monoclonal antibody,time after liver transplantation,complications(diabetes,hyperlipidemia,hypertension),withdrawal time and success rate between active withdrawal group and passive withdrawal group(P>0.05).Duration after liver transplantation in successful withdrawal group was significantly longer than that in failed withdrawal group(P<0.05).Conclusions The patients after liver transplantation with long-term survival can safely and completely withdraw immunosuppression under guidance by doctors,but should be followed up closely.