西罗莫司转换对超米兰标准肝癌肝移植患者肿瘤复发的影响

[目的] 研究西罗莫司为基础的免疫抑制方案对超出米兰标准肝癌肝移植患者的生存率及肿瘤复发的影响。[方法] 回顾性分析2010年6月到2011年6月我院器官移植科22例超米兰标准的肝癌肝移植患者，对他克莫司治疗组（CNIs）和转换为西罗莫司（SRL）治疗组进行资料分析。计量资料采用t检验，无复发生存率用Kaplan-Meier分析，所有数据用SPSS16.0计算，P<0.05为差异有统计学意义。[结果] 对22例患者平均随访12±3个月（7～18个月），两组间急性排斥反应发生率无明显差异；SRL组有4例复发，CNIs组有8例复发，Kaplan-Meier无复发生存曲线显示转换为SRL治疗的患者其肝癌无复发生存期明显高于CNIs组（P<0.05）。SRL组白细胞和血小板计数较CNIs组降低，具有统计学意义（P<0.05）。CNIs组有3例因肾损害转换为SRL治疗后肾功能均好转。SRL治疗组患者有2例发生口腔溃疡，没有发生肝动脉栓塞等严重并发症。[结论] 西罗莫司可有效用于超出米兰标准的肝癌肝移植患者，能够取得与CNIs类似的抗排斥反应效果，同时明显降低肿瘤复发的风险。

Effect of conversion to sirolimus-based immunosuppression on tumor recurrence after liver transplantation for hepatocellular carcinoma beyond the Standard Milan Criteria

Objective To investigate the effect of sirolimus (SRL)-based immunosuppression regimen on the survival and tumor recurrence in liver transplantation recipients with hepatocellular carcinoma beyond the standard Milan criteria. Methods We retrospectively analyzed 22 patients who received liver transplant in our hospital for HCC beyond the standard Milan criteria from June 2010 to June 2011. Eleven patients received tacrolimus for immunosuppression after liver transplant and the other 11 were converted from tacrolimus to SRL-based immunosuppression. The incidence rate of acute rejection, tumor-free survival period, blood routine, liver function and complications were compared between the two groups. Results The incidence rates of acute rejection were not significantly different between the two groups after a mean follow-up of (12±3) months (range, 7-18 months). Four patients in the SRL group and eight patients in tacrolimus group had HCC recurrence and metastasis. Kaplan-Meier recurrence-free survival curves demonstrated that SRL group had a significantly longer HCC recurrence-free survival than tacrolimus group(P<0.05). Compared with tacrolimus group, SRL group had significantly lower leukocyte and platelet counts (P<0.05). The tacrolimus-related nephrotoxicity was modestly improved in all the three patients after converted to SRL. Two patients suffered oral ulcers after conversion to SRL treatment and no severe complications such as arterial thrombosis were observed. ConclusionSRL can be effectively used for liver transplant recipients with hepatocellular carcinoma beyond the standard Milan criteria; it can achieve a similar anti-rejection effect to tacrolimus and can greatly reduce tumor recurrence.