[Effect of adjusting the immunosuppressants on the prognosis of the infection in the patients with liver transplantation].
OBJECTIVE
To explore the method of adjusting the immunosuppressants in serious infection after liver transplantation.


METHODS
With reference to sepsis-related organ failure assessment (SOFA), 2005.1-2007.12, when the patient's score > or =15, the immunosuppressants were withdrawn, and the patients were given powerful antibiotics and the other treatments in combination. They were further divided into two groups, SOFA 15-17 (group A, 10 cases) and > or =18 (group B, 16 cases). They were compared, and also with the patients without stoppage of immunosuppressants (group C, 13 cases, 2003.3-2004.12). After withdrawing the immunosuppressant, the rejection incidence and times, the changes in SOFA score and mortality and their relationships were analyzed.


RESULTS
After adjusting the immunosuppressant and with control of serious infections, rejection occurred in 9 patients, with 5 cases in group A (50.0%), 4 in B (25.0%), none in C. The differences among groups showed statistically significant difference (chi(2)=8.0, P=0.02), but no difference was seen between group A and B (chi(2)=1.70, P=0.19). When the rejection developed, the SOFA score decreased obviously (9.78+/-3.14 vs. 17.22+/-1.86, t=6.10, P=0.00). The time of rejection was (17.56+/-2.60) days after stopping the immunosuppressant. All 25 deaths were due to serious infection with multiple organ dysfunction syndrome, but not rejection. Five deaths occurred in group A (50.0%), 7 in B (43.8%), 13 in C (100.0%). Not a single patient with rejection died from infection. Proper adjustment of the immunosuppressants could decrease the mortality (chi(2)=7.60, P=0.02).


CONCLUSIONS
SOFA score could be used to guide the adjustment of the immunosuppressants, when SOFA> or =15, the immunosuppressants could be stopped, which would not increase the rejection incidence and decrease mortality. The lower the SOFA score is, the faster the patients recuperate better, but more rejection develops. In order to adjust the immunosuppressant in time, the period with high SOFA score should be shortened.
Liu
Shu-ren
SR
Liver Disease Center of the PLA, the 458th Hospital of the PLA, Guangzhou 510600, Guangdong, China.
Luo
Xian-rong
XR
Chen
Xiao-ping
XP
Luo
Li-min
LM
Yang
Jun
J
Zhu
Xin-yun
XY
Yu
Zhou-yao
ZY
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007239:Infections / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
D007166:Immunosuppressive Agents