Ju Wei-qiang, Guo Zhi-yong, Ling Xiaoting, He Xiao-shun, Wu Lin-wei, Tai Qiang, Hu An-bin, Han Ming, Zhu Xiao-feng
From the Organ Transplant Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Exp Clin Transplant. 2012 Jun;10(3):258-62. doi: 10.6002/ect.2010.0127.
To investigate the efficacy and safety of an immunosuppressive regimen of steroid avoidance in combination with induction therapy and tacrolimus in liver transplant recipients.
Eighty-two adult liver transplant recipients were randomized into 2 groups: standard protocol group (n=41) in which steroids were withdrawn 3 months after the operation, and a 24-hour steroid avoidance group (n=41) in which steroids were eliminated within 24 hours. The incidence of acute rejections, infections (bacterial, fungal, and cytomegalovirus), and metabolic complications were analyzed between the groups.
The incidence of early posttransplant diabetes mellitus and the average dosage of insulin consumption among diabetic recipients were significantly higher in recipients in the standard protocol group than in the 24-hour avoidance group (P < .05). In addition, the incidence of hypertension and infection during the follow-up were also higher in patients of the standard protocol group (P < .05). The incidence of hypertension in the early posttransplant period, hyperlipemia, and acute rejection during the follow-up were comparable between the groups (P > .05).
Twenty-four hour steroid avoidance combined with induction therapy and tacrolimus maintenance is a safe and efficient immunosuppression strategy that can significantly reduce posttransplant infections and other complications owing to long-term use of steroids, without increasing the risk of acute rejection.
探讨在肝移植受者中，避免使用类固醇联合诱导治疗及他克莫司的免疫抑制方案的疗效和安全性。
82例成年肝移植受者被随机分为两组：标准方案组（n = 41），术后3个月停用类固醇；24小时类固醇避免组（n = 41），在24小时内停用类固醇。分析两组之间急性排斥反应、感染（细菌、真菌和巨细胞病毒）及代谢并发症的发生率。
标准方案组受者移植后早期糖尿病的发生率及糖尿病受者胰岛素平均使用剂量显著高于24小时避免组（P < 0.05）。此外，标准方案组患者随访期间高血压和感染的发生率也更高（P < 0.05）。两组之间移植后早期高血压、高脂血症的发生率及随访期间急性排斥反应的发生率相当（P > 0.05）。
24小时类固醇避免联合诱导治疗及他克莫司维持治疗是一种安全有效的免疫抑制策略，可显著降低因长期使用类固醇导致的移植后感染及其他并发症，且不增加急性排斥反应的风险。
