Eguchi Susumu, Takatsuki Mitsuhisa, Soyama Akihiko, Hidaka Masaaki, Tokai Hirotaka, Hamasaki Koji, Miyazaki Kensuke, Tajima Yoshitsugu, Ichikawa Tatsuki, Kanematsu Takashi
Departments of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Sakamoto, Nagasaki, Japan.
Ann Transplant. 2007;12(4):11-5.
Recently we reported that signal transmission of interferon is more suppressed by tacrolimus (Tac) than cycrosporine (CyA). Therefore, although CyA might be beneficial immunosuppressive drug after liver transplantation (LT) on interferon therapy against hepatitis C virus, it is hesitated because of the risk for provocation of rejection. Herein initial outcome of our strategy, i.e. intentional conversion from Tac to CyA during preemptive interferon therapy after living donor LT (LDLT) was reported.
MATERIAL/METHODS: Of 62 patients who had undergone LDLT in Nagasaki University Hospital between 1997 and November 2006, 16 patients showed indications for hepatitis C-related liver cirrhosis. The median follow-up period was 15 months. Tac was used for all patients as induction therapy combined with steroids tapering.
In 11 out of 16 cases (68.8%), preemptive Pegylated (Peg)-IFN-alpha 2b+Ribavirin therapy was initiated. When Peg-IFN-alpha 2b+Ribavirin therapy was commenced, Tac-to- CyA conversion was done. The median period of conversion from Tac to CyA was 1.5 month after LDLT. After the conversion, ACR occurred in one case. Out of 11 patients, 3 patients (21.4%) showed early viral response (VR) at 3 months, 2 showed end-treatment response at 48 weeks (14.3%) and 3 showed sustained VR (21.4%).
Intentional conversion from Tac to CyA can be safely performed without increasing the risk of ACR.
最近我们报道，与环孢素（CyA）相比，他克莫司（Tac）对干扰素信号传导的抑制作用更强。因此，尽管CyA可能是肝移植（LT）后针对丙型肝炎病毒进行干扰素治疗时有益的免疫抑制药物，但由于存在引发排斥反应的风险，其使用仍存在争议。在此，我们报告了我们的策略的初步结果，即在活体供肝肝移植（LDLT）后进行抢先干扰素治疗期间有意将Tac转换为CyA。
材料/方法：1997年至2006年11月期间在长崎大学医院接受LDLT的62例患者中，16例表现出丙型肝炎相关肝硬化的指征。中位随访期为15个月。所有患者均使用Tac作为诱导治疗，并联合逐渐减量的类固醇。
16例患者中有11例（68.8%）开始了抢先聚乙二醇化（Peg）-干扰素-α2b+利巴韦林治疗。当开始Peg-干扰素-α2b+利巴韦林治疗时，进行了Tac至CyA的转换。从Tac转换为CyA的中位时间为LDLT后1.5个月。转换后，1例发生急性细胞排斥反应（ACR）。11例患者中，3例（21.4%）在3个月时出现早期病毒反应（VR），2例在48周时出现治疗结束时反应（1分），3例出现持续VR（21.4%）。
从Tac有意转换为CyA可以安全进行，而不会增加ACR的风险。
