Organ Transplantation Center, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China.
Hepatobiliary Pancreat Dis Int. 2012 Apr;11(2):137-42. doi: 10.1016/s1499-3872(12)60138-6.
Steroids have been the mainstay of immunosuppressive regimen in liver transplantation. However, the use of steroids is associated with various post-transplant complications. This study evaluated the efficacy and safety of reduced immunosuppressive regimen with steroids (steroid elimination within 24 hours post-transplant) in a cohort of Chinese liver transplant recipients.
Seventy-six patients in line with the selection criteria were enrolled in this prospective study. All patients received anti-IL-2 receptor antibody induction and tacrolimus-based maintenance therapy. The recipients were divided into two groups according to the duration of steroid use: 40 transplant in a 3-month withdrawal group and the remaining 36 in a 24-hour elimination group. Recipient survival, post-operative infections, biopsy-proven acute rejection and steroid-resistant acute rejection, non-healing wound, recurrence of hepatitis B virus (HBV) and hepatocellular carcinoma (HCC), de novo diabetes, hyperlipidemia and hypertension were assessed in the two groups.
There was no significant difference in patient survival, incidence of acute rejection episodes and hyperlipidemia, and recurrence of HBV and HCC between the two groups. However, the incidence rates of post-transplant infection, non-healing wound, de novo diabetes and hypertension were significantly lower in the 24-hour elimination group than in the 3-month withdrawal group (all P values <0.05).
Under anti-IL-2 receptor antibody induction and tacrolimus-based maintainance, steroid elimination within 24 hours post-transplant is associated with reduced steroid-related complications without increasing the risk of rejection.
类固醇一直是肝移植中免疫抑制方案的主要药物。然而，类固醇的使用与多种移植后并发症有关。本研究评估了在一组中国肝移植受者中，使用类固醇（移植后 24 小时内停用类固醇）的减少免疫抑制方案的疗效和安全性。
76 名符合入选标准的患者纳入本前瞻性研究。所有患者均接受抗白细胞介素-2 受体抗体诱导和他克莫司为基础的维持治疗。根据类固醇使用时间，将受者分为两组：40 例在 3 个月撤药组，其余 36 例在 24 小时消除组。评估两组受者的存活率、术后感染、经活检证实的急性排斥反应和类固醇耐药性急性排斥反应、伤口不愈合、乙型肝炎病毒（HBV）和肝细胞癌（HCC）复发、新发糖尿病、高脂血症和高血压。
两组患者的存活率、急性排斥反应发生率和高脂血症以及 HBV 和 HCC 的复发无显著差异。然而，与 3 个月撤药组相比，24 小时消除组的移植后感染、伤口不愈合、新发糖尿病和高血压发生率显著降低（均 P 值<0.05）。
在抗白细胞介素-2 受体抗体诱导和他克莫司为基础的维持治疗下，移植后 24 小时内消除类固醇与减少类固醇相关并发症相关，而不会增加排斥反应的风险。
