肝移植受者的类固醇减量：对丙型肝炎复发和移植后糖尿病的影响。

Steroid minimization in liver transplant recipients: impact on hepatitis C recurrence and post-transplant diabetes.

作者信息

Humar Abhinav, Crotteau Shaina, Gruessner Angelika, Kandaswamy Raja, Gruessner Rainer, Payne William, Lake John

机构信息

Department of Surgery, University of Minnesota, Minneapolis, MN, USA.

出版信息

Clin Transplant. 2007 Jul-Aug;21(4):526-31. doi: 10.1111/j.1399-0012.2007.00683.x.

DOI:10.1111/j.1399-0012.2007.00683.x

PMID:17645714

Abstract

BACKGROUND

Steroid minimization regimens have become increasingly popular for kidney transplant recipients. We studied outcomes for liver transplant recipients with a regimen using rapid discontinuation of prednisone (RDP).

RESULTS

The study group consisted of 83 recipients transplanted between June 2004 and January 2006. Immunosuppression consisted of tacrolimus, MMF, and two doses of basiliximab with six d of steroids. Patients with underlying autoimmune disorders (PSC, autoimmune hepatitis) were not included as they were maintained on steroids. The control group consisted of 83 recipients transplanted between January 2002 and May 2004. Immunosuppression consisted of tacrolimus, MMF and steroids, with no antibody induction. Mean MELD score at time of transplant was significantly higher in the steroid free group vs. the control group (28 vs. 23, p = 0.02); mean donor age was also higher (42 vs. 37 yr, p = 0.02). Other characteristics including recipient age, cold ischemic time, donor source, and cause of liver disease were similar (p = ns). Mean length of follow-up was 16.1 months in the RDP group and 32 months in the control group; a minimum of six months follow up was present for all patients. Patient and graft survival rates were not statistically different in the two groups (p = ns). Biopsy proven rejection was low in both groups and not significantly different (at one yr post-transplant 11% in the RDP group vs. 12% in control, p = 0.53). Based on protocol biopsy data, histologic recurrence of hepatitis C was demonstrated in 56% of the control group hepatitis C positive recipients vs. 39% in the RDP group (p = 0.05). There was a significantly lower incidence of post-transplant diabetes (PTDM) in the RDP vs. control group (at 6 months post-transplant 12% vs. 32%, p = 0.004).

CONCLUSIONS

Rapid discontinuation of prednisone in liver transplant recipients is not associated with an increased risk of rejection, and may be associated with lower morbidity, especially PTDM and hepatitis C recurrence.

摘要

背景

对于肾移植受者，激素最小化方案已越来越受欢迎。我们研究了肝移植受者采用快速停用泼尼松（RDP）方案的结局。

结果

研究组包括2004年6月至2006年1月期间接受移植的83名受者。免疫抑制方案包括他克莫司、霉酚酸酯（MMF）以及两剂巴利昔单抗，同时使用6天的类固醇。患有潜在自身免疫性疾病（原发性硬化性胆管炎、自身免疫性肝炎）的患者未纳入研究，因为他们持续使用类固醇。对照组包括2002年1月至2004年5月期间接受移植的83名受者。免疫抑制方案包括他克莫司、MMF和类固醇，未进行抗体诱导。无类固醇组移植时的平均终末期肝病模型（MELD）评分显著高于对照组（28对23，p = 0.02）；供者平均年龄也更高（42岁对37岁，p = 0.02）。其他特征，包括受者年龄、冷缺血时间、供者来源和肝病病因，两组相似（p = 无统计学意义）。RDP组的平均随访时间为16.1个月，对照组为32个月；所有患者的最短随访时间为6个月。两组的患者和移植物存活率无统计学差异（p = 无统计学意义）。两组经活检证实的排斥反应发生率均较低，且无显著差异（移植后1年，RDP组为11%，对照组为12%，p = 0.53）。根据方案活检数据，对照组丙型肝炎阳性受者中56%出现丙型肝炎组织学复发，而RDP组为39%（p = 0.05）。RDP组移植后糖尿病（PTDM）的发生率显著低于对照组（移植后6个月时分别为12%和32%，p = 0.004）。