西罗莫司用于治疗肝癌肝移植术后肿瘤复发患者的疗效分析

目的 探讨原发性肝细胞癌(肝癌)肝移植术后肿瘤复发患者在减少钙调磷酸酶抑制剂(他克莫司或环孢素)剂量并联用西罗莫司的临床疗效.方法 24例复发患者随机分为两组:研究组12例,确诊复发后即将钙调磷酸酶抑制剂减量并联合应用西罗莫司(3 mg/d,连用3 d后改为1.5 mg/d,按血药谷浓度4～8 ng/ml调整用量)治疗...

Effect of sirolimus application on liver allograft recipients with tumor recurrence

Objective To investigate the therapeutic effect of sirolimus application combined with dose-decreased calcineurin inhibitors on patients with tumor recurrence after orthotopic liver transplantation（OLT）.Methods Between January 2005 and March 2008,24 patients with tumor recurrence after OLT in our transplant center were enrolled in this study.Twelve patients（study group） were chosen randomly from the 24 patients and converted to sirolimus-based immunosuppression regimen after tumor recurrence（sirolimus was given at an initial loading dose of 3 mg/d for 3 days and followed by 1.5 mg/d with trough levels,which were maintained in the 4-8 ng/ml range）.The remaining 12 patients with their original immunosuppression regimen were studied as control group.The survival time of tumor bearing,the ratio of rejection and toxicity predicted to be associated with the drugs were compared between the two groups.Results In the study group,the median survival time in the presence of tumor was 17 months（3-37 months）.In the control group,the median survival time in the presence of tumor was 4 months（1-50 months）.There was significant difference in the survival time of tumor bearing after recurrence between these two groups（P0.05）.One recipient experienced acute rejection in the study group and the rejection was controlled by adding the dose of tacrolimus（FK506）.There was no acute rejection episode in the control group.But no statistically significant difference was observed（P0.05）.Compared with the control group,the study group had a higher rate of hyperlipemia（50 %）.There was no significant difference in the rate of other adverse reaction between these two groups（P0.05）.Conclusion Sirolimus is an effective immunosuppressant.At the same time,it may inhibit the growth of tumor and prolong the survival time of patients with tumor recurrence after OLT.It provides a new choice for the treatment of tumor recurrence after liver transplantation.