Samonakis D N, Mela M, Quaglia A, Triantos C K, Thalheimer U, Leandro G, Pesci A, Raimondo M L, Dhillon A P, Rolles K, Davidson B R, Patch D W, Burroughs A K
Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital, Hampstead, London, UK.
Transpl Infect Dis. 2006 Mar;8(1):3-12. doi: 10.1111/j.1399-3062.2006.00124.x.
Reducing immunosuppression not only reduces complications but also may lessen recurrent hepatitis C virus (HCV) infection after liver transplantation.
PATIENTS/METHODS: HCV-infected cirrhotic patients randomised to tacrolimus monotherapy (MT) or triple therapy (TT) using tacrolimus 0.1 mg/kg/day, azathioprine 1 mg/kg/day, and prednisolone 20 mg/day, tapering over 3 months.
Twenty-seven patients (MT) and 29 (TT)--median follow up 661 days (range, 1-1603). Rejection episodes (protocol/further biopsies) within first 3 months and use of empirical treatment were evaluated. New rejection was diagnosed if repeat biopsy (5-day interval) did not show improvement. Treated rejection episodes: 20 MT (15 biopsy-proven) vs. 24 TT (21 biopsy-proven), with 19 (MT) vs. 24 (TT) methylprednisolone boluses. Overall: 35 episodes (MT) and 46 (TT). Fewer MT patients had histological rejection (70%) than TT patients (86%), with fewer episodes of rejection (18.5% vs. 10%), and more moderate rejection (22% vs. 41%). The MT group had higher early tacrolimus levels. Rates of renal dysfunction, retransplantation, and death were not significantly different.
Tacrolimus monotherapy is a viable immunosuppressive strategy in HCV-infected liver transplant recipients.
减少免疫抑制不仅能降低并发症的发生，还可能减少肝移植后丙型肝炎病毒（HCV）的复发感染。
患者/方法：将HCV感染的肝硬化患者随机分为接受他克莫司单药治疗（MT）组或三联治疗（TT）组，他克莫司剂量为0.1mg/kg/天，硫唑嘌呤剂量为1mg/kg/天，泼尼松龙剂量为20mg/天，持续3个月逐渐减量。
27例患者接受MT治疗，29例接受TT治疗，中位随访时间为661天（范围1 - 1603天）。评估了前3个月内的排斥反应发作（方案规定的/进一步活检）及经验性治疗的使用情况。若重复活检（间隔5天）未显示改善，则诊断为新的排斥反应。接受治疗的排斥反应发作情况：MT组20例（15例经活检证实），TT组24例（21例经活检证实），MT组使用甲泼尼龙冲击治疗19例，TT组24例。总体情况：MT组35次发作，TT组46次发作。MT组组织学排斥反应的患者（70%）少于TT组（86%），排斥反应发作次数更少（18.5%对10%），中度排斥反应更多（22%对41%）。MT组早期他克莫司水平更高。肾功能不全、再次移植和死亡的发生率无显著差异。
对于HCV感染的肝移植受者，他克莫司单药治疗是一种可行的免疫抑制策略。
