Abstract:

Objective To investigate the usage of immunosuppressive agents after liver retransplantation.Methods The clinical data of 54 adult liver retransplantation patients were retrospectively analyzed. According to the application of immunosuppressive regimen，the patients were divided into 4 groups ：①corticosteroid + basiliximab + tacrolimus + mycophenolic acid（MPA）quadruple immunosuppressive regimen ；② corticosteroid + basiliximab + tacrolimus triple immunosuppressive regimen ；③ basiliximab + tacrolimus + MPA triple immunosuppressive regimen ；④ basiliximab + tacrolimus two immunosuppressive regimen. Cases of acute rejection and infection were calculated andprognosis was

recorded. Results Among 54 patients who underwent liver retransplantation，15 patients died in 1 year after surgery，and the remaining 39 patients survived for a long time. There were 9 cases（16.7%）with acute rejection and 34 cases（63.0%）with infection with in 1 year after operation. Among them，there were 31 patients in protocol 1，and 4 out of 31 had acute rejection（12.9%），20 cases had postoperative infections（64.5%）. There were 15 patients in protocol 2，and 3 out of 15 hadacute rejection（20.0%）and 10 cases had postoperative infections（66.7%）; There were only 1 case in protocol 3，there was no acute convulsion（0%），1 case had postoperative infection（100%）; And there were 7 patients in protocol 4，2 out of 7 had acute rejection（28.6%），3 cases occurred postoperative infection（42.9%）. All the cases with acute rejection were relieved after increasing the dose of tacrolimus or the treatment with methylprednisolone. A total number of 12 infected patients died of infection，and the remaining 22 patients improved after anti-infective treatment. Conclusion The immune status of patients after liver retransplantation is complicated，and individualized immunosuppressive therapy is essential.

Key words: Liver retransplantation, Immunosuppressive regimen, Acute rejection, Infection

摘要：

目的 探讨再次肝移植术后免疫抑制剂的使用。方法 回顾性分析 54 例再次肝移植患者的临床资料，免疫抑制剂方案为 ：① 皮质激素 + 巴利昔单抗 + 他克莫司 + 吗替麦考酚酯四联免疫抑制方案 ；② 皮质激素 + 巴利昔单抗 + 他克莫司三联免疫抑制方案 ；③ 巴利昔单抗 + 他克莫司 + 吗替麦考酚酯三联免疫抑制方案 ；④ 巴利昔单抗 + 他克莫司两联免疫抑制方案。分别计算各方案中发生感染或排斥反应的病例数及其预后转归。结果 54 例成人再次肝移植患者，术后 1 年内死亡 15 例，其余 39 例患者长期存活。术后 1 年内急性排斥反应 9 例（16.7%），感染 34 例（63.0%）。其中方案 1 共 31 例患者，4 例发生急性排斥反应（12.9%），20 例发生术后感染（64.5%）；方案 2 共 15 例患者，3 例发生急性排斥反应（20.0%），10 例发生术后感染（66.7%）；方案 3 共 1 例患者，0 例发生急性排斥反应（0%），1 例发生术后感染（100%）；方案 4 共 7 例患者，2 例发生急性排斥反应（28.6%），3 例发生术后感染（42.9%）。所有发生急性排斥反应的病例经增加他克莫司用量或甲强龙冲击治疗后症状均缓解，感染患者死亡 12 例，其余 22 例患者经对症抗感染治疗后好转。结论 再次肝移植术后患者的免疫状态复杂，个体化免疫抑制治疗至关重要。

关键词: 再次肝移植 , 免疫抑制方案 , 急性排斥反应 , 感染