良性重症终末期肝病肝移植术后免疫抑制剂治疗179例分析

目的：总结良性重症终末期肝病肝移植术后免疫抑制剂的应用经验,探讨个体化用药方案的价值。方法：回顾分析2002年4月—2010年8月术前终末期肝病模型（MELD）评分≥25分的179例肝移植病例资料,分为3个阶段：第一阶段（2002年4月—2004年12月）65例,第二阶段（2005年1月—2007年12月）64例,第三阶段（2008年1月—2010年8月）50例。第一阶段采用他克莫司（Tac）＋吗替麦考酚酯（MMF）＋甲基强的松龙（MP）的常规三联用药方案,第二阶段采用减量的三联用药方案,第三阶段采用个体化免疫抑制方案。比较3个阶段存活率、感染死亡率和排斥反应发生率。结果：第一、第二、第三阶段患者的存活率呈逐渐升高的趋势;患者感染死亡病例数占相应阶段病例总数比率为27.7%、17.2%、8.0%,差异有统计学意义（P〈0.05）;患者感染死亡病例数占相应阶段死亡病例数比率为85.7%、64.7%、44.4%,呈下降趋势,第三阶段与第一阶段比较,差异有统计学意义（P〈0.05）;第三阶段与第二阶段排斥反应发生率差异无统计学意义（P〉0.05）,与第一阶段比较排斥反应发生率虽然轻度升高（P〈0.05）,但是存活率却由67.7%提高到82.0%。结论：良性重症终末期肝病肝移植术后免疫抑制剂的个体化应用,减少了用药量,降低了感染死亡率,有利于提高患者存活率。

Individual immunosuppressive protocol after liver transplantation in benign severe end-stage liver disease: a single center experience of 179 cases

Objective: To analyze the individual immunosuppressive protocol(IP) after liver transplantation(LT) in benign severe end-stage liver disease.Method: The clinical data of 179 cases benign severe end-stage liver disease preoperative MELD score≥25 performed LT in our institute from April 2002 to Aug 2010 were analyzed retrospectively.The traditional IP containing Tacrolimus(Tac),Mycophenolate mofetil(MMF) and Methylprednisolone(MP) was used in stage one(65 cases from April 2002 to Dec 2004).The decrement of immunosuppressant than traditional IP was used in stage two(64 cases from Jan 2005 to Dec 2007);The individual IP was used in stage three(50 cases from Jan 2008 to Aug 2010).The survival rate,the infected mortality rate and the incidence of rejection in three different IP stage were analyzed.Results: The overall survival rate of patients in three stages was up gradually.The infected mortality rate of patients in stage one,stage two and stage three was 27.7%,17.2% and 8.0%,there were significant difference among them(P<0.05).The ratio of the cases died from infection to the overall dead cases in stage one,stage two and stage three was 85.7%,64.7% and 44.4%,the difference between stage three and stage one was significant(P<0.05).The incidence of rejection between stage three and stage two had no significant difference(P>0.05),although the incidence of rejection in stage three was higher than that in stage one slightly(P<0.05),the survival rate increased from 67.7% in stage one to 82% in stage three.Conclusion: The individual IP can elevate the survival rate of patients,decrease the infected mortality rate and the dose of immunosuppressant.