肝移植术后撤除免疫抑制剂的回顾性分析
Retrospective analysis of immunosuppression drug withdrawal after liver transplantation
Received date: 2020-08-25
Online published: 2022-08-03
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。
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 . DOI: 10.16139/j.1007-9610.2021.03.011
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 One case had complete immunosuppression withdrawn for 74 months.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
| [1] | Gelson W, Hoare M, Dawwas MF, et al. The pattern of late mortality in liver transplant recipients in the United Kingdom[J]. Transplantation, 2011, 91(11):1240-1244. |
| [2] | Benítez C, Londoño M, Miquel R, et al. Prospective multicenter clinical trial of immunosuppressive drug withdrawal in stable adult liver transplant recipients[J]. He-patology, 2013, 58(5):1824-1835. |
| [3] | Feng S, Ekong UD, Lobritto SJ, et al. Complete immunosuppression withdrawal and subsequent allograft function among pediatric recipients of parental living donor liver transplants[J]. JAMA, 2012, 307(3):283-293. |
| [4] | 赵东, 夏强. 肝移植相关领域的研究进展[J]. 国际消化病杂志, 2020, 40(2):71-74. |
| [5] | Schoening W, Neidel N, Buescher N, et al. Cardiovascular risk and events after liver transplantation. Expe-riences from 313 consecutive transplants with a follow-up of 20 years[J]. Clin Transplant, 2015, 29(4):343-350. |
| [6] | Rubín A, Sánchez-Montes C, Aguilera V, et al. Long-term outcome of “long-term liver transplant survivors”[J]. Transpl Int, 2013, 26(7):740-750. |
| [7] | Messner F, Etra JW, Dodd-O JM, et al. Chimerism, transplant tolerance, and beyond[J]. Transplantation, 2019, 103(8):1556-1567. |
| [8] | Baroja-Mazo A, Revilla-Nuin B, Parrilla P, et al. Tole-rance in liver transplantation: biomarkers and clinical re-levance[J]. World J Gastroenterol, 2016, 22(34):7676-7691. |
| [9] | Chen Y, Chen J, Liu Z, et al. Relationship between TH1/TH2 cytokines and immune tolerance in liver transplantation in rats[J]. Transplant Proc, 2008, 40(8):2691-2695. |
| [10] | Harmon C, Sanchez-Fueyo A, O'farrelly C, et al. Natural killer cells and liver transplantation: orchestrators of rejection or tolerance?[J]. Am J Transplant, 2016, 16(3):751-757. |
| [11] | Chen L, Zhang L, Zhu Z, et al. Effects of IL-10- and FasL-overexpressing dendritic cells on liver transplantation tolerance in a heterotopic liver transplantation rat model[J]. Immunol Cell Biol, 2019, 97(8):714-725. |
| [12] | Ma B, Yang JY, Song WJ, et al. Combining exosomes derived from immature DCs with donor antigen-specific Treg cells induces tolerance in a rat liver allograft model[J]. Sci Rep, 2016, 6:32971. |
| [13] | Huang H, Lu Y, Zhou T, et al. Innate immune cells in immune tolerance after liver transplantation[J]. Front Immunol, 2018, 9:2401. |
| [14] | Jhun J, Lee SH, Lee SK, et al. Serial monitoring of immune markers being represented regulatory T cell/T helper 17 cell ratio: indicating tolerance for tapering immunosuppression after liver transplantation[J]. Front Immunol, 2018, 9:352. |
| [15] | Pérez-Sanz F, Revilla-Nuin B, Martínez-Alarcón L, et al. Tolerance biomarkers in liver transplantation: independent external validation of the predictive strength of SENP6 and FEM1C gene expression[J]. Transplantation, 2019, 103(9):1887-1892. |
| [16] | Shaked A, Desmarais MR, Kopetskie H, et al. Outcomes of immunosuppression minimization and withdrawal early after liver transplantation[J]. Am J Transplant, 2019, 19(5):1397-1409. |
| [17] | Sánchez-Fueyo A. Hot-topic debate on tolerance: immunosuppression withdrawal[J]. Liver Transpl, 2011, 17 Suppl 3:S69-S73. |
| [18] | Trotter JF, O′grady J. Operational tolerance after liver transplantation: raising the bar or tripping up?[J]. Am J Transplant, 2010, 10(10):2193-2194. |
| [19] | de la Garza RG, Sarobe P, Merino J, et al. Trial of complete weaning from immunosuppression for liver transplant recipients: factors predictive of tolerance[J]. Liver Transpl, 2013, 19(9):937-944. |
| [20] | Assy N, Adams PC, Myers P, et al. Randomized controlled trial of total immunosuppression withdrawal in li-ver transplant recipients: role of ursodeoxycholic acid[J]. Transplantation, 2007, 83(12):1571-1576. |
| [21] | González-Koch A, Czaja AJ, Carpenter HA, et al. Recurrent autoimmune hepatitis after orthotopic liver transplantation[J]. Liver Transpl, 2001, 7(4):302-310. |
/
| 〈 |
|
〉 |