Zhou Lin, Du Guo-Sheng, Pan Li-Chao, Zheng Yong-Gen, Liu Zhi-Jia, Shi Hai-Da, Yang Shao-Zhen, Shi Xian-Jie, Xuan Meng, Feng Li-Kui, Zhu Zhi-Dong
Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, P.R. China.
Department of Hepatobiliary Surgery, Organ Transplant Institute, Chinese PLA 309th Hospital, Beijing 100091, P.R. China.
Oncol Lett. 2017 Dec;14(6):7817-7824. doi: 10.3892/ol.2017.7217. Epub 2017 Oct 18.
There is currently no consensus on the most suitable therapeutic approach for psoriasis (PS) co-existing with posthepatic cirrhosis (PCs) and hepatocellular carcinoma (HCC) following liver transplantation (LT). The present study provides an analysis of the therapeutic experience of such patients. Five LT recipients (two with PC and three with HCC) with accompanying PS were included. The induction program consisted of methylprednisolone plus basiliximab treatment. The initial postoperative treatment scheme consisted of tacrolimus (FK506) plus mycophenolate mofetil (MMF) and hormone; the latter was withdrawn 1 week after LT. The patients with PC had been using FK506 with or without a postoperative MMF program; the patients with HCC and recurrence of PS had been switched to a sirolimus (SRL)-based replacement therapy. Furthermore, all patients received anti-hepatitis B virus (HBV) therapy. The patients were followed up after 8.3±1.5 years. There was a positive correlation between HBV-DNA copy numbers, and psoriatic area and severity index (PASI) scores (r=0.97; P=0.006). The PASI scores were decreased significantly at 6 months following surgery compared with pre-transplantation (P<0.05). The patients who had received the FK506-based treatment experienced PS recurrence two years post-transplantation. The PASI scores increased significantly (P<0.05) and then declined gradually, maintaining a stable level (P<0.05) by 1 year after switching to the SRL-based treatment. The patients who had received the SRL-based treatment exhibited no recurrence of PS. The results of the present study suggest that SRL therapy provides a promising novel treatment method for patients with PS following LT that may be superior to tacrolimus treatment. When co-existing HBV is present pre-transplantation, regular injection of human hepatitis B immunoglobulin should be used to prevent the HBV from relapsing or aggravating the PS.
目前，对于肝移植（LT）后合并肝后性肝硬化（PCs）和肝细胞癌（HCC）的银屑病（PS）患者，尚无关于最合适治疗方法的共识。本研究对这类患者的治疗经验进行了分析。纳入了5例伴有PS的LT受者（2例患有PC，3例患有HCC）。诱导方案包括甲泼尼龙加巴利昔单抗治疗。术后初始治疗方案包括他克莫司（FK506）加霉酚酸酯（MMF）和激素；后者在LT后1周停用。患有PC的患者一直在使用FK506，术后使用或不使用MMF方案；患有HCC且PS复发的患者已改用基于西罗莫司（SRL）的替代疗法。此外，所有患者均接受抗乙型肝炎病毒（HBV）治疗。对患者进行了8.3±1.5年的随访。HBV-DNA拷贝数与银屑病面积和严重程度指数（PASI）评分之间存在正相关（r = 0.97；P = 0.006）。与移植前相比，术后6个月PASI评分显著降低（P < 0.05）。接受基于FK506治疗的患者在移植后两年出现PS复发。PASI评分显著升高（P < 0.05），然后逐渐下降，在改用基于SRL的治疗后1年保持稳定水平（P < 0.05）。接受基于SRL治疗的患者未出现PS复发。本研究结果表明，SRL疗法为LT后PS患者提供了一种有前景的新治疗方法，可能优于他克莫司治疗。移植前存在合并HBV时，应定期注射人乙型肝炎免疫球蛋白，以防止HBV复发或加重PS。
