Abstract
The different choices of immunosuppression (IS) regimens influenced the outcomes of liver transplantation. Steroid was applied as a standard IS to prevent and treat rejections. However, steroid-related complications were increasingly prominent. This study compared the efficacy and safety of standard IS regimens with the efficacy and safety of steroid-free IS regimen and induction IS regimen in Chinese liver transplantation recipients for hepatocellular carcinoma (HCC). A total of 329 patients who underwent liver transplantation from January 2008 to December 2012 were retrospectively reviewed. Three different groups of patients received standard triple-drug IS regimen of steroid, tacrolimus (TAC) and mycophenolate mofetil (MMF) (triple-drug regimen group; n=57), induction-contained IS regimen of basiliximab, steroid, TAC and MMF (BS group; n=241), and induction-contained and steroid-free regimen of basiliximab, TAC and MMF (SF group; n=31), respectively. There were no significant differences in terms of patient, tumor-free and graft survival rates. The acute rejection rate and rejection time were equivalent in different groups. But compared with BS group, higher incidences of biliary complications (11.52% vs. 30.77%, p=0.013) and graft dysfunction (0.48% vs. 13.64%, p=0.003) were observed in SF group. Furthermore, compared with the two groups, incidence of pleural effusion was also higher in SF group (15.79%, 11.96% vs. 45.45%, respectively, both p<0.01). And a trend towards less proportion of De novo diabetes was revealed in SF group. Although it was found that patient, tumor-free and graft survival rates were equivalent among three IS regimens, higher incidences of complications were demonstrated in steroid-free regimen in patients for HCC. These findings suggested that steroid-free IS regimen has no clear advantages in comparison with standard IS regimens for liver transplant recipients with HCC and the postoperative complications should be treated with concentrated attention.
Highlights
As a common malignancy worldwide, the incidence and mortality of hepatocellular carcinoma (HCC) varies widely with geographical region
This study found that the incidences of complications which included biliary complications and graft dysfunction were higher in recipients who received steroid-free IS regimen, compared with recipients who received induction-contained regimen
The incidence of pleural effusion was higher in SF group than in triple-drug regimen group and basiliximab with steroid (BS) group
Summary
As a common malignancy worldwide, the incidence and mortality of hepatocellular carcinoma (HCC) varies widely with geographical region. The results indicate that due to the endemic feature of long-term chronic HBV infection, HCC is more prevalent in Asia [2] especially in China. The usage of IS reduces the acute and chronic rejections, which are the severe side effects after transplantation. Evidences indicated that quit a few of the long-term complications of liver transplantation (LTx) were caused by IS side effects rather than chronic rejection, and in other words transplant recipients were being overimmunosuppressed [6]. Up to 1980s, two revolutionized IS, Cyclosporine (CsA) and Tacrolimus (TAC), were applied as the pivotal drugs in LTx. Up to 1980s, two revolutionized IS, Cyclosporine (CsA) and Tacrolimus (TAC), were applied as the pivotal drugs in LTx The former was reported crucially to reduce the incidence of allograft rejection combining with corticosteroids (CS) and AZA. Standard regimen of steroid and calcineurin inhibitors (CNIs) is the most extensively treatment which is applied in the world
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