title: 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.
authors: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Yuan-Yuan
authors: YY
authors: Liu
authors: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Chang-Ping
authors: CP
authors: Li
authors: Department of Transplantation, Tianjin First Center Hospital, 24 Fu-Kang Road, Nankai District, Tianjin, 300192, China.
authors: Ming-Sheng
authors: MS
authors: Huai
authors: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Xiao-Meng
authors: XM
authors: Fu
authors: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Zhuang
authors: Z
authors: Cui
authors: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Lin-Lin
authors: LL
authors: Fan
authors: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Shu
authors: S
authors: Zhang
authors: Follow-up Center, Department of Transplantation, Tianjin First Center Hospital, 24 Fu-Kang Road, Nankai District, Tianjin, 300192, China.
authors: Yuan
authors: Y
authors: Liu
authors: Department of Health Statistics, School of Public Health, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Jun
authors: J
authors: Ma
authors: Department of Biology, School of Basic Medical, Tianjin Medical University, 22 Qi-Xiang-Tai Road, Heping District, Tianjin, 300070, China.
authors: Guang
authors: G
authors: Li
authors: Department of Transplantation, Tianjin First Center Hospital, 24 Fu-Kang Road, Nankai District, Tianjin, 300192, China.
authors: Zhong-Yang
authors: ZY
authors: Shen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy / Q000145:classification*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D013256:Steroids; D015996:Survival Rate; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D013256:Steroids