不同免疫抑制方案对肝癌肝移植后无复发生存的影响。

Effect of different immunosuppressive schedules on recurrence-free survival after liver transplantation for hepatocellular carcinoma.

机构信息

Department of Surgery and Transplantation, University of Bologna, S.Orsola Hospital, Bologna, Italy.

出版信息

Transplantation. 2010 Jan 27;89(2):227-31. doi: 10.1097/TP.0b013e3181c3c540.

DOI:10.1097/TP.0b013e3181c3c540

PMID:20098287

Abstract

BACKGROUND

Tumor recurrence represents the main limitation of liver transplantation in patients with hepatocellular carcinoma (HCC) and can be favored by exposure to calcineurin inhibitors.

METHODS

We investigated the effect of an immunosuppressant schedule that minimizes the exposure to calcineurin inhibitors on patients transplanted for HCC to ascertain whether this can reduce the tumor recurrence rate. For this purpose, we conducted a matched-cohort study: 31 patients with HCC transplanted between 2004 and 2007 who received sirolimus as part of their immunosuppression (group A) were compared with a control group of 31 patients (group B) transplanted in the same period who had the same prognostic factors but were given standard immunosuppression based on tacrolimus.

RESULTS

Three-year recurrence-free survival was 86% in group A and 56% in group B (P=0.04). Although the prevalence of microvascular invasion G3-G4 grading and alpha-fetoprotein more than 200 ng/mL was identical in the two groups, exposure to tacrolimus was significantly higher in patients of group B (median, 8.54; range, 5.5-13.5) in comparison with those of group A (median, 4.6; range, 1.8-9.1) (P=0.0001).

CONCLUSIONS

By using sirolimus, exposure to calcineurin inhibitors can be minimized, reducing the risk of HCC recurrence.

摘要

背景

肿瘤复发是肝癌患者肝移植的主要限制因素，而钙调磷酸酶抑制剂的暴露可能会促进肿瘤复发。

方法

我们研究了一种将钙调磷酸酶抑制剂暴露最小化的免疫抑制方案对移植治疗肝癌患者的影响，以确定这是否可以降低肿瘤复发率。为此，我们进行了一项匹配队列研究：31 例 2004 年至 2007 年间接受西罗莫司作为免疫抑制剂一部分的 HCC 移植患者（A 组）与同一时期接受基于他克莫司的标准免疫抑制但具有相同预后因素的 31 例对照患者（B 组）进行比较。