以西罗莫司为主的免疫抑制方案在肝细胞癌肝移植术后的应用

目的:评估西罗莫司为主的免疫抑制方案在肝细胞癌行肝移植术后应用的安全性及对术后肿瘤复发和生存的影响。方法:回顾性分析2006年1月至2013年1月在本院肝移植中心因肝细胞癌行肝移植手术的64例病人的临床资料,根据术后是否应用西罗莫司分为西罗莫司组和他克莫司组,比较两组移植术后急性排异、肝动脉栓塞、胆道并发症、切口并发症、代谢疾病、肿瘤复发和病人生存等情况。结果:两组在急性排异、肝动脉栓塞、胆道并发症和切口并发症的发生率方面差异无统计学意义(P>0.05),西罗莫司组新发糖尿病的发生率显著低于他克莫司组,而高血脂的发生率则高于他克莫司组(P<0.05)。与他克莫司组比,西罗莫司组肿瘤1年复发率明显降低,累积生存率明显升高(P<0.05)。结论:肝细胞癌肝移植术后西罗莫司为主的免疫抑制方案并不增加移植术后急性排异、肝动脉栓塞、胆道并发症和切口并发症的发生率,且可延迟肿瘤的复发,提高病人的生存率。

Effects of sirolimus-based immunosuppressive protocol on recurrence of hepatocellular carcinoma after liver transplantation

Objective To investigate the influence of sirolimus-based immunosuppressive protocols on safety and efficacy of patients with hepatocellular carcinoma （HCC） after liver transplantation （LT）. Methods The clinical data of 64 patients with HCC after LT were retrospectively analyzed from January 2006 to January 2013. They were divided into sirolimus group and tacolimus group according to the use of sirolimus. The main postoperative complications, recurrence of tumor and survival rate were compared between two groups. Results There was no significant difference in the incidence rate of the acute cellular rejection convinced by biopsy, hepatic artery thrombosis, anastomotic biliary stricture and incision complications between two groups （P〉0.05）. Compared with the tacrolimus group, the sirolimus group showed significantly lower incidence of the new-onset diabetes mellitus and higher incidence of the hyperlipidemia and hypercholesterolemia （P〈0.05）. The recurrence rate of HCC at 1 year after LT significantly decreased and the curative survival rate increased significantly in the sirolimus group （P〈0.05）. Conclusions Sirolimus-based immunosuppressive protocol does not increase the incidence of acute rejection, hepatic artery thrombosis, anastomotic biliary stricture and incision complications in LT patients with HCC, and delays tumor recurrence and prolongs survival of patient.