Berlakovich G A, Rockenschaub S, Taucher S, Kaserer K, Mühlbacher F, Steiniger R
Department of Transplant Surgery, University of Vienna, Austria.
Arch Surg. 1998 Feb;133(2):167-72. doi: 10.1001/archsurg.133.2.167.
As significantly more patients die of infection than of rejection after liver transplantation, we have to conclude that overimmunosuppression is common. Our analysis was performed to investigate underlying disease as an appropriate parameter for individually reduced immunosuppression.
A consecutive series of patients receiving primary liver transplantation was analyzed with regard to acute rejection.
Department of transplantation surgery in a university hospital.
From 1988 to 1995, 252 patients received liver transplantation for posthepatitic cirrhosis, alcoholic cirrhosis, cholestatic disease, or hepatoma and were analyzed in a univariate and multivariate manner.
The influence of various underlying diseases on the incidence of acute rejection.
The estimated risk for freedom from acute rejection and analysis of cumulative rates of acute rejection stratified by group showed significant differences between the groups, except for alcoholic and posthepatitic cirrhosis. Severity of acute rejection episodes, as assessed by the need for rescue therapy, was similar in both univariate analysis and cumulative rates for alcoholic and posthepatitic cirrhosis. As expected, patients with cholestatic disease exhibited a significantly increased requirement for rescue therapy. For patients with hepatoma, a low incidence of initial and a high rate of repeated rescue therapy were observed. The varying immunological behavior within this group may have influenced both expansion of the tumor and severity of acute rejection. Multivariate analysis of potential risk factors identified underlying disease as a variable of independent prognostic significance for acute rejection and the need to receive rescue therapy.
These results indicate the importance of taking the original disease into consideration where immunosuppressive therapy is concerned.
由于肝移植术后死于感染的患者明显多于死于排斥反应的患者，我们不得不认为免疫抑制过度的情况很常见。我们进行此项分析是为了研究基础疾病作为个体化降低免疫抑制的合适参数。
对接受初次肝移植的一系列连续患者进行急性排斥反应分析。
一所大学医院的移植外科。
1988年至1995年期间，252例因肝炎后肝硬化、酒精性肝硬化、胆汁淤积性疾病或肝癌接受肝移植的患者，进行单因素和多因素分析。
各种基础疾病对急性排斥反应发生率的影响。
除酒精性肝硬化和肝炎后肝硬化外，各亚组急性排斥反应的无事件生存风险估计值及累积发生率分析显示各亚组间存在显著差异。根据抢救治疗需求评估的急性排斥反应发作严重程度，在酒精性和肝炎后肝硬化的单因素分析和累积发生率中相似。正如预期的那样，胆汁淤积性疾病患者的抢救治疗需求显著增加。对于肝癌患者，观察到初始发生率低且重复抢救治疗率高。该组内不同的免疫行为可能影响了肿瘤的进展和急性排斥反应的严重程度。对潜在危险因素的多因素分析确定基础疾病是急性排斥反应及接受抢救治疗需求的独立预后意义变量。
这些结果表明在免疫抑制治疗中考虑原发病的重要性。
