RÉSUMÉ
Objective To study the clinical efficacy of steroid-free immunosuppressive therapy after liver transplantation in patients with primary liver cancer.Methods A retrospective study was conducted on the clinical data from January 2010 to October 2016 on 112 patients with primary liver cancer.There were 59 patients who had no steroid immunosuppressive regimen after operation,and 53 patients were in the steroid group.The immunosuppressive regimen used in the postoperative steroid-free group was tacrolimus + mycophenolate mofetil + basiliximab.For the steroid group it was:tacrolimus + mycophenolate moxibustion.The steroid was reduced daily in the first day after transplantation and was discontinued 3 months after transplantation.Follow-up observation of the differences between the two groups of patients on rejection,infection,tumor recurrence,hepatitis B virus recurrence and survival were compared.Results The infection rate was 18.6％ in the postoperative steroid-free group,which was significantly lower than that in the steroid group (37.7％,P ＜0.05).The recurrence rate of hepatitis B virus in the postoperative steroid-free group was 5.1％,which was significantly lower than that in the steroid group (20.8％,P ＜ 0.05).For patients who exceeded the Milan Criteria,the tumor recurrence rate was 70.0％ in the postoperative steroid-free group,which was lower than the 100％ in the steroid group (P ＜0.05).The 1-year,3-year and 5-year survival rates in the postoperative steroid-free group were 96.4％,84.9％ and 69.3％,respectively,which were better than the 87.8％,64.9％ and 44.3％ (P ＜0.05) in the steroid group.The incidences of rejection were not significantly different (P ＞ 0.05).Conclusions The use of the steroid-free immunosuppressive regimen in patients with hepatocellular carcinoma after transplantation was safe and did not increase the incidence of acute rejection.The regimen reduced the incidences of postoperative infection and hepatitis B virus recurrence,especially in patients who exceeded the Milan Criteria.It reduced the risk of tumor recurrence and improved patient survival.
RÉSUMÉ
Objective To study the clinical efficacy of steroid-free immunosuppressive therapy after liver transplantation in patients with primary liver cancer.Methods A retrospective study was conducted on the clinical data from January 2010 to October 2016 on 112 patients with primary liver cancer.There were 59 patients who had no steroid immunosuppressive regimen after operation,and 53 patients were in the steroid group.The immunosuppressive regimen used in the postoperative steroid-free group was tacrolimus + mycophenolate mofetil + basiliximab.For the steroid group it was:tacrolimus + mycophenolate moxibustion.The steroid was reduced daily in the first day after transplantation and was discontinued 3 months after transplantation.Follow-up observation of the differences between the two groups of patients on rejection,infection,tumor recurrence,hepatitis B virus recurrence and survival were compared.Results The infection rate was 18.6％ in the postoperative steroid-free group,which was significantly lower than that in the steroid group (37.7％,P ＜0.05).The recurrence rate of hepatitis B virus in the postoperative steroid-free group was 5.1％,which was significantly lower than that in the steroid group (20.8％,P ＜ 0.05).For patients who exceeded the Milan Criteria,the tumor recurrence rate was 70.0％ in the postoperative steroid-free group,which was lower than the 100％ in the steroid group (P ＜0.05).The 1-year,3-year and 5-year survival rates in the postoperative steroid-free group were 96.4％,84.9％ and 69.3％,respectively,which were better than the 87.8％,64.9％ and 44.3％ (P ＜0.05) in the steroid group.The incidences of rejection were not significantly different (P ＞ 0.05).Conclusions The use of the steroid-free immunosuppressive regimen in patients with hepatocellular carcinoma after transplantation was safe and did not increase the incidence of acute rejection.The regimen reduced the incidences of postoperative infection and hepatitis B virus recurrence,especially in patients who exceeded the Milan Criteria.It reduced the risk of tumor recurrence and improved patient survival.
RÉSUMÉ
Objective To compare the efficacy of open microwave ablation and repeat hepatectomy for recurrent small hepatocellular carcinoma.Methods The clinical data of 75 patients with recurrent small HCC who were admitted to our hospital from January 2007 to December 2010 were retrospectively analyzed.34 received microwave ablation (MWA group) and 41 received repeat hepatectomy (hepatectomy group).The perioperative condition,liver function recovery,the variation of AFP level,mobidities,hospitalization time and overall survival rate and disease-free survival rate were compared.Results The rate of complete elimination to tumor tissue was 100％ and the AFP levels returned to normal within 3 months in both groups.The mean average operation time in MWA group was shorter than that in hepatectomy group [(91 ±33) min vs (156 ±51) min,t =-6.399 5,P =0.000].The blood loss in MWA group was smaller than that in hepatectomy group [(87 ±62) ml vs (254 ± 134) ml,t =-6.691 5,P =0.000].Patients in PFRA group had a shorter hospital stay [(7.5 ± 2.2) d vs (11.3 ± 2.7) d,t =-6.588 8,P =0.000].The mobidities of the MWA group and hepateetomy group were 2.9％ (1/34) and 22.0％ (9/41),respectively (x2 =5.812 7,P =0.016).The overall survive rate of 1,3 and 5-year were 88.1％,68.8％ and 46.1％ in the MWA group,and 86.1％,71.5％ and 50.2％ in the hepatectomy group (x2 =0.16,P =0.692).The disease free survival rate of 1,3 and 5-year were 67.1％,38.2％ and 16.1％ in the MWA group,and 64.4％,45.5％ and 23.6％ in the hepatectomy group (x2 =0.03,P =0.870).Conclusions MWA can achieve survival benefits equivalent to hepatectomy for recurrent small HCC,and it is less traumatic.
RÉSUMÉ
TGR5,expressing in many tissue cells,is a kind of bile acid membrane receptor and participates in a variety of metabolic and immune diseases.Activated TGR5 can keep the metabolism system in a steady state by mediating the metabolism of bile acid,lipid,and blood sugar,reducing insulin resistance and increasing the body's energy consumption; TGR5 could regulate the immune responses of mononuclear cell and Kupffer cell in the liver.For example,it can regulate the adaptive immune response by inhibiting the expression and release of inflammatory cytokines in Kupffer cells,and regulating the differentiation and maturation of dendritic cells.This review mainly focused on the function of TGR5 in liver metabolism and immune and further explored the related mechanism,as well as its clinical significance in related liver diseases.