Department of Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, China (mainland).
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, Guangdong, China (mainland).
Med Sci Monit. 2019 Mar 14;25:1936-1944. doi: 10.12659/MSM.915128.
BACKGROUND Hyperbilirubinemia is a common event that occurs after liver transplantation. Hyperbilirubinemia is usually caused by early allograft dysfunction. Glucocorticoid is widely used for immunosuppression, but few studies have analyzed the effects of steroid therapy on posttransplantation hyperbilirubinemia. The aim of this study was to assess whether glucocorticoid was beneficial in treating hyperbilirubinemia caused by early allograft dysfunction. MATERIAL AND METHODS Patients with postoperative hyperbilirubinemia (those with conditions such as biliary complications and rejections were excluded) were randomly assigned, in a 2: 1 ratio, to the steroid and control groups. Patients in the steroid group were treated with glucocorticoid combined with ursodeoxycholic acid, whereas patients in the control group were only treated with ursodeoxycholic acid. The primary endpoint was decrease in bilirubin and the secondary endpoint was safety. RESULTS From 1st June 2016 to 30th April 2018, 40 patients were enrolled into the steroid group, and 20 were enrolled into the control group. Donor, recipient, and operative data were similar between the 2 groups. The decrease in bilirubin levels in the steroid group was significantly greater than that in the control group on the first day after the intervention was finished (9.25±1.30 mg/dL vs. 3.11±1.45 mg/dL, p=0.005), and after 2 weeks (15.01±1.20 mg/dL vs. 8.88±1.98 mg/dL, p=0.007). The steroid group did not have a higher complication rate but it did have a shorter postoperative hospital stay than in the control group. CONCLUSIONS Low-dose steroid therapy was effective and safe for treating hyperbilirubinemia caused by early graft dysfunction, and it improved liver function.
肝移植后会发生高胆红素血症，这是一种常见的事件。高胆红素血症通常是由早期移植物功能障碍引起的。糖皮质激素被广泛用于免疫抑制，但很少有研究分析类固醇治疗对移植后高胆红素血症的影响。本研究旨在评估糖皮质激素是否有利于治疗早期移植物功能障碍引起的高胆红素血症。
术后高胆红素血症患者（排除有胆道并发症和排斥等情况的患者）被随机以 2:1 的比例分配到激素组和对照组。激素组患者接受糖皮质激素联合熊去氧胆酸治疗，而对照组患者仅接受熊去氧胆酸治疗。主要终点是胆红素下降，次要终点是安全性。
2016 年 6 月 1 日至 2018 年 4 月 30 日，40 例患者入组激素组，20 例患者入组对照组。两组供者、受者和手术数据相似。干预结束后第 1 天，激素组胆红素水平下降明显大于对照组（9.25±1.30mg/dL 比 3.11±1.45mg/dL，p=0.005），2 周后（15.01±1.20mg/dL 比 8.88±1.98mg/dL，p=0.007）。激素组并发症发生率没有更高，但术后住院时间比对照组短。
小剂量激素治疗对治疗早期移植物功能障碍引起的高胆红素血症有效且安全，并能改善肝功能。
