A national report from China Liver Transplant Registry: steroid avoidance after liver transplantation for hepatocellular carcinoma

查看全文 作　　者：Qiang [1]Wei;Feng [1]Gao;Runzhou [1]Zhuang;Qi [1]Ling;Qinghong [1]Ke;Jian [1]Wu;Tian [1]Shen;Mangli [1]Zhang;Min [1]Zhang;Xiao [1,2]Xu;Shusen [1,2]Zheng

机构地区：[1]Key Lab of Combined Multi-Organ Transplantation, Ministry of Public Health, Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine;[2]Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases

出　　处：《Chinese Journal of Cancer Research》索引2017年第29卷第5期,共12页

基　　金：supported by the Cheung Kong Scholars Program;the Zhejiang Provincial Program for the Cultivation of Highlevel Innovative Health Talents;the Projects of Medical and Health Technology Program in Zhejiang Province (No. 2015KYB151 and 2017RC002) 摘　　要：Objective:We aimed to evaluate the efficacy and safety of steroid-free immunosuppression after liver transplantation(LT)for hepatocellular carcinoma(HCC).Methods:We retrospectively analyzed HCC recipients without steroids after LT(SF group,n=368)based on the China Liver Transplant Registry(CLTR)database.These recipients were matched 1:2 with patients using steroids(S group,n=736)for the same period after LT for HCC,according to propensity scores.Results:Multivariate analysis indicates that recipients with younger age[odds ratio(OR),1.053;P=0.011],preoperative hepatitis B virus(HBV)DNA≥1,000 copies/mL(OR,2.597;P=0.004)and beyond Milan criteria(OR,4.255;P<0.001)were identified as the risk factors associated with tumor recurrence in steroid avoidance recipients after LT.The patients fulfilling the Milan criteria in the SF group presented higher overall and tumor-free survival rates than those in the S group(P<0.05).Multivariate analysis revealed that recipient beyond Milan criteria was an independent prognostic factor for overall survival(OR,1.690;P<0.001)and tumor-free survival(OR,2.066;P<0.001).The incidences of new-onset diabetes mellitus(21.20% vs.33.29%,P<0.001),new-onset hypertension(10.05%vs.18.61%,P<0.001)and hyperlipidemia(4.08% vs.7.20%,P=0.042)were significantly lower in the SF group.Conclusions:Steroid-free immunosuppression could be safe and feasible for HBV-related HCC patients in LT.Age,HBV DNA level and Milan criteria maybe risk factors associated with tumor recurrence in steroid avoidance recipients.Recipient beyond Milan criteria was an independent prognostic factor and recipient fulfilling Milan criteria can benefit the most from steroid-free immunosuppression. 关键词：肝移植类固醇中国回避癌 HCC 免疫力后评估

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A national report from China Liver Transplant Registry: steroid avoidance after liver transplantation for hepatocellular carcinoma

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