Comprehensive Comparison of Three Different Immunosuppressive Regimens for Liver Transplant Patients with Hepatocellular Carcinoma: Steroid-Free Immunosuppression, Induction Immunosuppression and Standard Immunosuppression

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.

Effects of an immunosuppressive treatment on the rat prostate

“… 3 Moreover, the choice of an appropriate immunosuppressive treatment protocol is of great importance. 4 – 6 Consideration should be given to protocols with low levels of adverse effects, so that approaches would largely translate into the quality of life of patients.…”

Warm ischemia time and elevated serum uric acid are associated with metabolic syndrome after liver transplantation with donation after cardiac death

“…For immunosuppressive protocol, we used the standard three-drug regimen including steroid, tacrolimus/cyclosporine, and mycophenolate mofetil (MMF). For recipients with hepatocellular carcinoma (HCC), steroid-free protocol was applied as described by Shen et al[ 8 ].…”

Update: Immunsuppression bei Organtransplantationen

“…Das mögliche Ausschleichen (▶ Tab. 4) und Absetzen von Kortison wurde in mehreren Studien untersucht und aufgearbeitet [28,29]. Die Therapie der akuten Abstoßung wird in Form einer hochdosierten Kortisongabe (500-1000 mg) über 3- Erhaltungstherapie Merke Der Goldstandard der Erhaltungstherapie nach NTx, der auch in den Leitlinien [32] empfohlen ist, besteht aus einer Kombination von CyA oder TAC, MMF und Steroiden.…”