Clinical efficacy of steroid-free immunosuppressive regimen after liver transplantation for patients with primary liver cancer / 中华肝胆外科杂志

ABSTRACT

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 wastacrolimus + 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.