肝移植术后撤除免疫抑制剂的回顾性分析

doi:10.16139/j.1007-9610.2021.03.011

摘要/Abstract

摘要：

目的：分析肝移植病人术后完全撤除免疫抑制剂的临床资料。方法：回顾性分析自2013年1月至2020年6月本中心撤除免疫抑制剂的15例肝移植病人临床资料。结果：11例因严重免疫抑制剂不良反应而被动撤药,平均撤药时间（10.4±6.2）个月。2例发生急性排斥反应。撤药成功率81.8%。主动撤药的4例病人平均撤药时间（28.8±30.3）个月,全部撤药成功（100%）,其中1例已完全撤药74个月。主动撤药组与被动撤药组相比,在性别、年龄、体质量指数、使用单抗诱导、撤药时肝移植术后时间、合并症（糖尿病、高血脂、高血压）、撤药时间以及撤药成功率的差异无统计学意义（P>0.05）。撤药成功组撤药时肝移植术后时间明显长于撤药失败组（P<0.05）。结论：长期生存的肝移植病人在医师指导下可完全撤除免疫抑制剂,但应严密随访。

关键词: 肝移植, 免疫抑制剂, 撤除, 免疫耐受

Abstract:

Objective To analyze the clinical data of patients with immunosuppression drug withdrawal after liver transplantation. Methods The clinical data of 15 patients with immunosuppression drug withdrawal after liver transplantation in our center from January 2013 to June 2020 were analyzed retrospectively. Results Eleven patients had immunosuppression withdrawal passively with time(10.4±6.2) months because of severe adverse effects. Two cases had acute rejection and success rate was 81.8%. The withdrawal time of 4 patients with active immunosuppression withdrawal was (28.8±30.3) months, and withdrawal was all successful(100%). One case had complete immunosuppression withdrawn for 74 months. There were no statistically significant differences in terms of sex, age, body mass index, induction of monoclo-nal antibody, time after liver transplantation, complications(diabetes, hyperlipidemia, hypertension), withdrawal time and success rate between active withdrawal group and passive withdrawal group (P>0.05). Duration after liver transplantation in successful withdrawal group was significantly longer than that in failed withdrawal group(P<0.05). Conclusions The patients after liver transplantation with long-term survival can safely and completely withdraw immunosuppression under guidance by doctors, but should be followed up closely.

Key words: Liver transplantation, Immunosuppression, Withdrawl, Immune tolerance

中图分类号:

R657.3

戚德彬, 陈鹏, 佟辉, 彭承宏, 李涛. 肝移植术后撤除免疫抑制剂的回顾性分析[J]. 外科理论与实践, 2021, 26(03): 231-235.

QI Debin, CHEN Peng, TONG Hui, PENG Chenghong, LI Tao. Retrospective analysis of immunosuppression drug withdrawal after liver transplantation[J]. Journal of Surgery Concepts & Practice, 2021, 26(03): 231-235.

图/表 4

表1

一般临床资料

病例号	性别	年龄 (岁)	BMI (kg/m²)	原发病	单抗诱导	撤药时肝移植术后时间（月）	糖尿病	高血脂	高血压	撤药原因	撤药前	撤药前药物剂量	末次药物浓度(μg/L)
1	男	39	26.3	肝豆状核变性	否	146	否	否	否	主动	他克莫司	0.5 mg,每12 h 1次	2.4
2	男	67	28.1	乙肝后肝硬化失代偿	否	204	是	是	是	被动：肾功能损害	西罗莫司	1 mg,每天 1次	3.4
3	男	75	26.7	乙肝后肝硬化失代偿	否	183	是	是	是	被动：肾功能损害,骨髓抑制	他克莫司	0.5 mg,隔天 1次	0.6
4	女	63	23.2	乙肝后肝硬化失代偿	是,舒莱	126	是	是	是	被动：肾功能损害,骨髓抑制	西罗莫司	1 mg,隔天 1次	1.6
5	男	71	27.6	酒精性肝硬化失代偿	是,舒莱	138	是	是	是	被动：肺癌	西罗莫司	1 mg,每天 1次	2.1
6	男	49	25.7	肝细胞肝癌合并乙肝肝硬化	否	82	否	是	否	被动：肝癌复发及肺转移	西罗莫司	1 mg,每天 1次	3.2
7	男	29	19.8	肝门胆管癌	否	13	否	否	否	被动：肺、骨、肝转移	西罗莫司	2 mg,每天 1次	4.3
8	男	65	24.5	肝门胆管癌	是,舒莱	157	否	否	是	主动	他克莫司	0.5 mg,每天 1次	0.6
9	男	71	28.0	乙肝后肝硬化失代偿	否	175	是	是	是	被动：膀胱癌	西罗莫司	1 mg,每天 1次	2.4
10	男	68	29.4	乙肝后肝硬化失代偿	否	106	否	是	是	被动：淋巴瘤	西罗莫司	1 mg,每天 1次	1.8
11	男	87	26.5	乙肝后肝硬化失代偿	是,舒莱	183	否	否	是	被动：肾功能损害	他克莫司	0.5 mg,隔天 1次	0.4
12	女	69	24.2	乙肝后肝硬化失代偿	否	208	否	否	否	主动	他克莫司	0.5 mg,每12 h 1次	1.2
13	男	75	23.3	乙肝后肝硬化失代偿	是,舒莱	179	否	是	是	主动	他克莫司	0.5 mg,每天 1次	0.5
14	男	65	24.6	乙肝后肝硬化失代偿	否	192	是	否	否	被动：结肠癌	他克莫司	0.5 mg,每12 h 1次	2.1
15	男	62	19.2	肝细胞癌合并乙肝后肝硬化	是,舒莱	18	否	是	否	被动：肝癌复发及肺、骨转移	西罗莫司	1 mg,每天 1次	3.2

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参考文献 21

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项目	主动撤药组（n=4）	被动撤药组（n=11）	t值	P值
男/女（n）	3/1	10/1		0.476
平均年龄（岁）	62.0±15.9	64.3±14.9	0.257	0.801
BMI（kg/m²）	24.6±1.3	25.4±3.4	0.438	0.668
单抗诱导[n（%）]	2	4（36.4）		1.000
撤药时肝移植术后时间（月）	172.5±27.4	129.1±67.9	1.219	0.245
合并糖尿病[n（%）]	0	6（54.5）		0.103
合并高血脂[n（%）]	1	8（72.7）		0.235
合并高血压[n（%）]	2	7（63.6）		1.000
撤药时间(月)	28.8±30.3	10.4±6.2	2.018	0.065
撤药成功率[n（%）]	4	9（81.8）		1.000

项目	撤药成功组（n=13）	撤药失败组（n=2）	t值	P值
男/女（n）	11/2	2/0		1.000
平均年龄（岁）	66.0±11.9	29, 68	1.672	0.118
BMI（kg/m²）	25.2±2.5	19.8, 29.4	0.271	0.790
单抗诱导 [n（%）]	6（46.2）	0		0.486
撤药时肝移植术后时间（月）	153.2±53.5	13, 106	2.259	0.042^a)
合并糖尿病 [n（%）]	6（46.2）	0		0.486
合并高血脂 [n（%）]	8（61.5）	1		1.000
合并高血压 [n（%）]	8（61.5）	1		1.000
撤药时间(月)	16.8±18.0	3, 9	0.817	0.429