肝癌患者肝移植术后早期激素撤离对肿瘤复发的影响

目的 探讨肝癌患者肝移植术后激素撤离对肿瘤复发的影响。方法 对54例中、晚期原发性肝癌患者施行了肝移植，术后根据3个月内是否撤离激素分为激素撤离组（28例）和激素维持组（26例）。比较两组间排斥反应发生率、半年及1年的肿瘤复发率、1年存活率、血他克莫司（FK506）浓度及生化指标的平均值，运用统计学方法分析两组间差异。结果 激素撤离组和激素维持组排斥反应发生率、半年肿瘤复发率、1年存活率相比，差异无统计学意义；激素维持组1年肿瘤复发率明显高于激素撤离组，差异有统计学意义（P〈0．05）。术后半年，两组FK506浓度的差异无统计学意义。术后1周及术后半年，两组丙氨酸转氨酶、胆红素总量及肌酐分别相比，差异均无统计学意义。术后半年，两组胆固醇总量、中餐前血糖水平相比，差异均有统计学意义（P〈0．05）。结论 肝癌患者肝移植术后3个月内撤离激素是安全的，并不增加排斥反应的发生率，也不需要增加其它免疫抑制剂的用量，可明显降低肿瘤复发率，提高患者的长期存活率。

Impact of steroid withdrawal on recurrent rate of carcinoma after liver transplantation of hepatocellular carcinoma

Objective To investigate the impact of steroid withdrawal on the recurrent rate of carcinoma after liver transplantation of hepatocellular carcinoma.Methods Forty-five patients with middle and advanced hepatocellular carcinoma undergoing liver transplantation were divided into two groups:steroid withdrawal group in which steroid was withdrawn in 3 months after operation,and prednisone group.The rate of rejection,(0.5)-and one-year tumor recurrent rate,serum FK506 concentration and biochemical parameters were compared between two groups.Results There was no significant difference between the two groups in rate of rejection, serum FK506 concentration,liver and kidney function,(0.5)-and one-year recurrent rate.However,the tumor one-year recurrent rate in prednisone group was obviously higher than in the steroid withdrawal group(P<(0.05)).Six months after operation,there was significant difference in total cholesterol and blood glucose level before lunch betweenthe two groups(P<(0.05)).Conclusions Steroid withdrawal within 3 months after liver transplantation) can't increase the incidence of rejection and the dosage of immunosuppressants,obviously reduce the tumor recurrent rate and prolong the long-term survival rate of the patients with hepatocellular carcinoma.