Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China; Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, Key Laboratory of Organ Transplantation, Hangzhou 310003, China; Key Laboratory of Organ Transplantation, Hangzhou 310003, China; Collaborative Innovation Center for Diagnosis Treatment of Infectious Diseases, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2018 Jun;17(3):204-209. doi: 10.1016/j.hbpd.2018.05.001. Epub 2018 May 17.
Previous studies have emphasized the need to reduce tacrolimus (TAC) trough levels in the early post-liver transplantation (LT) period. However, whether late-period TAC trough levels influence the long-term outcomes of liver recipients is not clear.
We enrolled 155 adult liver recipients survived more than 3 years after living donor liver transplantation because of non-malignant liver diseases. The maintenance immunosuppressive regimens were TAC monotherapy and combined therapy with mycophenolate mofetil. Patients were divided into three groups according to their late-period TAC trough levels: < 3 ng/mL group, 3-5 ng/mL group, and >5 ng/mL group. The complications and adverse effects of TAC were analyzed.
Each group showed similar rejection, graft loss and mortality. Patients achieved the < 5 ng/mL state in less than 4 years had fewer new-onset diabetes, hyperlipidemia, de novo malignancies, and hepatitis B virus recurrence; the complications of renal dysfunction and hypertension rates were the same among these 3 groups.
Collectively, our findings indicated that lower TAC trough levels in the late period of liver transplantation are safe, improve the long-term outcomes.
既往研究强调肝移植（LT）后早期需降低他克莫司（TAC）谷浓度。然而，TAC 谷浓度是否会影响肝移植受者的长期预后尚不清楚。
我们纳入了 155 例因非恶性肝脏疾病接受活体供肝移植后生存 3 年以上的成年肝移植受者。维持性免疫抑制方案为 TAC 单药治疗和霉酚酸酯联合治疗。根据 TAC 谷浓度的晚期水平将患者分为三组：<3ng/ml 组、3-5ng/ml 组和>5ng/ml 组。分析 TAC 的并发症和不良反应。
每组的排斥反应、移植物丢失和死亡率均相似。在不到 4 年内达到<5ng/ml 状态的患者新发糖尿病、高血脂、新发恶性肿瘤和乙型肝炎病毒再感染的发生率较低；肾功能不全和高血压的并发症发生率在这 3 组中相同。
综上所述，我们的研究结果表明肝移植后期较低的 TAC 谷浓度是安全的，可改善长期预后。
