Gómez R, Moreno E, Colina F, Loinaz C, Gonzalez-Pinto I, Lumbreras C, Perez-Cerdá F, Castellón C, García I
General and Digestive Surgery, Liver Transplantation Unit, University Hospital, 12 de Octubre, Madrid, Spain.
J Hepatol. 1998 Jan;28(1):150-6. doi: 10.1016/s0168-8278(98)80214-6.
In the immunosuppression of orthotopic liver transplant recipients, steroids are used despite their unspecific action and long-term side effects. Few studies have been carried out on steroid withdrawal and many aspects remain to be elucidated.
A prospective study was performed to analyse the effect of steroid withdrawal on 86 patients with stable graft function, more than 1 year after orthotopic liver transplant. Thirty patients had chronic hepatitis in the graft. Seventy-two continued with cyclosporine (CsA) and 14 with CsA-azathioprine (AZA) therapy. The follow-up was 23.2 +/- 8.1 months (range 12-52 months). A paired t-test was used for statistical analysis.
No acute or chronic rejection occurred, and steroids were not reinstituted. There were no changes in serum transaminase levels, but bilirubin levels decreased (p < 0.01). At the end of the follow-up, we found improvements in blood pressure in hypertensive patients (systolic 156.1 +/- 8.4 mmHg vs. 139.4 +/- 8.7 mmHg, p < 0.001); body weight (72 +/- 13.5 kg vs. 70.8 +/- 13 kg, p < 0.05); serum cholesterol (211.3 +/- 42 mg/dl vs. 191.6 +/- 43.5 mg/dl, p < 0.001) and bone mineral density in lumbar spine (0.823 +/- 0.13 g/cm2 vs. 0.893 +/- 0.135 g/cm2, p < 0.001). Four of ten diabetic patients were no longer insulin-dependent and insulin requirements decreased in the remaining six. No significant biochemical changes were found in patients with hepatitis in the graft, and we found an improvement in inflammatory activity in the nine biopsied patients.
Steroid withdrawal with CsA monotherapy is feasible, safe and beneficial in patients who have stable liver graft function 1 year after orthotopic liver transplant. We consider that AZA therapy is not necessary unless drastic reduction of CsA levels is required because of renal dysfunction.
在原位肝移植受者的免疫抑制治疗中，尽管类固醇具有非特异性作用和长期副作用，但仍被使用。关于类固醇撤减的研究较少，许多方面仍有待阐明。
进行了一项前瞻性研究，以分析86例移植肝功能稳定、原位肝移植术后1年以上患者的类固醇撤减效果。30例患者的移植肝患有慢性肝炎。72例继续使用环孢素（CsA）治疗，14例使用CsA - 硫唑嘌呤（AZA）治疗。随访时间为23.2±8.1个月（范围12 - 52个月）。采用配对t检验进行统计分析。
未发生急性或慢性排斥反应，类固醇未重新使用。血清转氨酶水平无变化，但胆红素水平下降（p < 0.01）。随访结束时，我们发现高血压患者的血压有所改善（收缩压156.1±8.4 mmHg对139.4±8.7 mmHg，p < 0.001）；体重（72±13.5 kg对70.8±13 kg，p < 0.05）；血清胆固醇（211.3±42 mg/dl对191.6±43.5 mg/dl，p < 0.001）以及腰椎骨密度（0.823±0.13 g/cm²对0.893±0.135 g/cm²，p < 0.001）。10例糖尿病患者中有4例不再依赖胰岛素，其余6例的胰岛素需求量减少。移植肝患有肝炎的患者未发现明显的生化变化，我们发现9例接受活检的患者的炎症活动有所改善。
对于原位肝移植术后1年移植肝功能稳定的患者，采用CsA单一疗法撤减类固醇是可行、安全且有益的。我们认为，除非因肾功能不全需要大幅降低CsA水平，否则不需要AZA治疗。
