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Comprehensive comparison of three different immunosuppressive regimens for liver transplant patients with hepatocellular carcinoma: steroid-free immunosuppression, induction immunosuppression and standard immunosuppression.

Liu YY, Li CP, Huai MS, Fu XM, Cui Z, Fan LL, Zhang S, Liu Y, Ma J, Li G, Shen ZY - PLoS ONE (2015)

Bottom Line: There were no significant differences in terms of patient, tumor-free and graft survival rates.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.

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.

No MeSH data available.


Related in: MedlinePlus

Overall survival rates of recipients in three IS groups (log-rank test, p = 0.213).
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pone.0120939.g002: Overall survival rates of recipients in three IS groups (log-rank test, p = 0.213).

Mentions: In all recipients, the 1-year, 3-year and 5-year OS rates were 86.40%, 74.02% and 66.14%, respectively. And the 1-year, 3-year and 5-year OS rates were 80.66%, 67.78%, and 63.26% in triple regimen group, 89.25%, 77.88%, and 66.94% in BS group, and 77.18%, 58.81%, and 58.81% in SF group, respectively. No significant difference was observed in three groups for OS rates (p = 0.213) (Fig. 2). Of 102 recipients who met Milan criteria, there were 22 (21.57%), 75 (73.53%) and 5 (4.90%) recipients in three groups, respectively.


Comprehensive comparison of three different immunosuppressive regimens for liver transplant patients with hepatocellular carcinoma: steroid-free immunosuppression, induction immunosuppression and standard immunosuppression.

Liu YY, Li CP, Huai MS, Fu XM, Cui Z, Fan LL, Zhang S, Liu Y, Ma J, Li G, Shen ZY - PLoS ONE (2015)

Overall survival rates of recipients in three IS groups (log-rank test, p = 0.213).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4376790&req=5

pone.0120939.g002: Overall survival rates of recipients in three IS groups (log-rank test, p = 0.213).
Mentions: In all recipients, the 1-year, 3-year and 5-year OS rates were 86.40%, 74.02% and 66.14%, respectively. And the 1-year, 3-year and 5-year OS rates were 80.66%, 67.78%, and 63.26% in triple regimen group, 89.25%, 77.88%, and 66.94% in BS group, and 77.18%, 58.81%, and 58.81% in SF group, respectively. No significant difference was observed in three groups for OS rates (p = 0.213) (Fig. 2). Of 102 recipients who met Milan criteria, there were 22 (21.57%), 75 (73.53%) and 5 (4.90%) recipients in three groups, respectively.

Bottom Line: There were no significant differences in terms of patient, tumor-free and graft survival rates.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).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.

View Article: PubMed Central - PubMed

Affiliation: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.

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.

No MeSH data available.


Related in: MedlinePlus