肝联合其他器官移植术后近期免疫抑制策略的方案探讨

目的探讨肝联合其他器官移植术后近期的免疫抑制策略。方法我中心于2004年至2009年共实施肝联合其他器官移植22例，其中肝肾联合移植17例，肝胰十二指肠联合移植5例。存活时间大于3个月的患者共18例，比较此类患者与单一器官移植患者术后近期排斥反应发生率和免疫抑制策略的差别。结果肝联合其他器官移植的患者术后3个月内，移植肝排斥反应发生率为5．5％；移植肾的排斥反应发生率为5．9％；其他器官没有发生排斥反应，较我中心单一器官移植排斥反应发生率低。同时，肝联合其他器官移植患者免疫抑制剂初始剂量及术后近期所需浓度均较单一器官移植低。结论肝联合其他器官移植的患者，由于移植肝对其他移植器官的免疫保护作用，排斥反应发生率低，所需免疫抑制剂初始剂量及浓度均低于单一器官移植。但肝脏对其他移植器官的免疫保护作用机制尚需进一步研究。

Study of immunosuppressive management for patients accepted simultaneous combined liver and other organs transplantation

Objective To investigate the proper dose of immunosuppressive agent for patients after simultaneous combined liver and other organs transplantation. Methods A total of 22 patients were performed simultaneous combined liver and other organ transplantation in our center between 2004 and 2009 ,including 17 cases of combined liver and kidney transplantation and 5 cases of combined liver and pancreas transplantation. 18 patients survived more than 3 months. The acute rejection rate, the initial dose and needed level of immunosuppressive agent of these patients were analyzed, and compared to those of single organ transplantation. Results During the 3 months after operation, acute rejection rate of these patients was 5.5% in the transplanted liver and 5.9% in the transplanted kidney. No rejection was found in other organs. These were lower than those of single organ transplantation. Meanwhile the initial dose and the needed level of immunosuppressive agent were lower than those of single organ transplantation. Conclusion Because the immunosuppressive protection of other organ by the liver transplanted simultaneously, the acute rejection rate in the patients underwent combined liver and other organ transplantation is lower than that of patient underwent single organ transplantation. And initial dose and needed level of immunosuppressive agent should be reduced. The lower use of immunosuppressive agent can reduce the occurrence of infections and graft toxicity. The mechanism of the immunosuppressive protection of other organ by liver transplanted simultaneously is need to be further studied.