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Objective To investigate the clinical efficacy of basiliximab-induced glucose-free corticosteroid immunosuppressive regimen after liver transplantation.Methods The retrospective cohort study was conducted.The clinicopathological data of 227 patients with liver transplantation who were admitted to Bayi Hospital affiliated to Nanjing University of Traditional Chinese Medicine from January 2010 to October 2016 were collected.Of the 227 patients,125 who postoperatively received a glucose-free corticosteroid immunosuppressive regimen using a monoclonal antibody + tacrolimus + mycophenolate mofetil tablets were allocated into the hormone-free group,and 102 who were postoperatively treated with the immunosuppressive regimen using glucocorticoid steroid + tacrolimus + mycophenolate mofetil tablets were allocated into the hormone group.Observation indicators:(1) comparison of follow-up and survival;(2) comparison of postoperative infection,rejection and biliary stenosis between groups.Follow-up using outpatient examination and telephone interview was performed to detect postoperative survival,infection,rejection and biliary stenosis up to June 2017.The measurement data with normal distribution were represented as (x) ± s,and comparison between groups was done by the t test.Measurement data with skewed distribution were described as M (P25,P75) and M (range),and comparison between groups was analyzed using the rank sum test.The count data were compared by the chi-square test.Kaplan-meier method was used to draw survival curve and calculated survival rate.Log-rank test was used for survival analysis.Results (1) Comparison of follow-up and survival:patients between groups were followed up for 9-89 months,with a median time of 45 months.The 1-and 3-year overall survival rates were respectively 93.25％,85.24％ in the hormone-free group and 89.89 ％,74.22％ in the hormone group,with a statistically significant difference (x2 =8.450,P＜0.05).(2) Comparison of postoperative infection,rejection and biliary stenosis between groups:① The total cases with postoperative infections,cases with infection of Klebsiella pneumoniae,Staphylococcus aureus,Candida,Acinetobacter baumannii and Stenotrophomonas maltophilia were 25,18,3,2,2,0 in the hormone-free group and 40,26,6,3,3,2 in the hormone group,respectively,showing a statistically significant difference between groups (x2 =10.149,P＜0.05).The patients between groups with postoperative infection were treated with active anti-infective symptomatic treatment.Three patients in the hormone group died of severe pulmonary infection,and the remaining patients in both groups were improved.② The cases with postoperative rejection in the hormone-free group and hormone group were 6 and 5,respectively,with no statistically significant difference (x2 =0.950,P＞ 0.05).The rejection of both groups occurred within 1 week postoperatively.Two patients in the hormone group were treated with glucocorticoid hormonal shock.The other patients in the 2 groups were improved by adjusting the amount of tacrolimus and mycophenolate mofetil tablets.③ The cases with postoperative biliary stenosis in the hormone-free group and the hormone group were 32 and 8 respectively,with a statistically significant difference (x2 =12.200,P＜0.05).In the hormone group,biliary stenosis occurred after stopping glucocorticoids.The patients with biliary stenosis were improved after biliary stent implantation by endoscopic retrograde cholangio pancreatography (ERCP).Conclusion The basiliximab-induced glucose-free corticosteroid immunosuppressive regimen after liver transplantation is safe and feasible,and it can significantly reduce the incidence of postoperative infection and improve long-term overall survival compared with the conventional glucocorticoid immunosuppressive regimen,but increased postoperative biliary stenesis.
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Objective To approach the effect of telbivudine for preventing recurrence of virus and improving renal function in patients with hepatitis B cirrhosis after liver transplantation with renal insufficiency,and observe the mid-and long-term efficacy.Methods We prospectively researched 17 cases of hepatitis B cirrhosis after liver transplantation with renal insufficiency.Maintenance irnmunosuppression protocol at our centre mainly included calcineurin inhibitor (tacrolimus for 12 cases,and sirolimus for 5 cases).These recipients (n =17) remained under the entecavir (n =10),tenofovir (n =4),lamivudine + adefovir (n =3) for at least 6 months before transformation to telbivudine.We detected HBV-DNA level in serum and ensured no rejection during study,necessarily punctured the graft liver for biopsy to determine if there was rejection.The basal values of blood serum creatinine (Scr) and estimated glomerular filtration rate (eGFR,CKD-EPI formula) were recorded.The Scr and eGFR at 6th month before research and basal values and at 6th and 12th month after telbivudine administration were detected,at the same time the general state and adverse reactions were evaluated.Results During the average follow-up period of 20.2 months,1 patients died.The Ser levels detected in the rest 16 patients were 105.74± 18.24,112.26± 18.67,96.48±22.0 and 89.17± 19.56μμmol/L respectively at 6th month before,basal time and 6th,12th month after telbivudine administration.The eGFR values were 72.56 ± 14.39,66.23 ± 16.61,79.77 ± 20.15 and 83.93 ± 23.67 mL/(minute,m2) at different time points respectively.As compared with the basal value,the Scr and eGFR levels were improved obviously (P＜0.05) at 6th and 12th month after telbivudine administration.The proportion of patients with eGFR ＜60 mL/(min·m2) in 16 cases was 25％,37.5％,12.5％ and 6.3％ respectively at 6th month before,basal time and 6th,12th month after telbivudine administration.The serum creatine phosphokinase level was increased (1 023 IU/L) in 1 patient (6.3％),and decreased after transformation of telbivudine to tenofovir at 3rd month after end of research.No rejection and HBV occurred.Conclusion The telbivudine improves renal function in patients with hepatitis B cirrhosis after liver transplantation with renal insufficiency.Meanwhile,telbivudine prevents hepatitis virus B recurrence.However,large samples of long-term clinical data are needed to further confirm.
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BACKGROUND:Fluorouracil sustained-release agent is a commonly used anti-cancer sustained-release drug, which has a good anti-tumor effect. OBJECTIVE:To explore the effect of fluorouracil sustained-release agent in the treatment of gastric cancer. METHODS:Literatures concerning the effect of fluorouracil sustained-release agent in the treatment of gastric cancer were retrieved and analyzed. In the paper, we investigated the preventive effect of fluorouracil sustained-release agent against tumor recurrence and metastasis after radical resection, and fol owed up the patients who underwent clinical peritoneal implantation of fluorouracil sustained-release agent. We could determine the effect of fluorouracil sustained-release agent in the treatment of advanced gastric cancer by observing the patient’s symptoms and signs, expression of tumor markers, tumor size and survival rate. RESULTS AND CONCLUSION:After combination therapy of fluorouracil sustained-release agent and arterial infusion chemotherapy adjuvant therapy, the patient’s symptoms and tumor resection rate were significantly improved. The levels of CEA, CA19-9, CA72-4 in the serum of patients significantly reduced, while the apoptosis and necrosis of tumor cells significantly increased. Fluorouracil sustained-release agent could also reduce tumor metastasis and local recurrence, and improve patient survival.
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Objective To observe the curative effect of sirolimus conversion for liver transplantation patients with chronic renal injury.Methods In 23 recipients of liver transplantation using CNI (19 cases using tacrolimus,and 4 cases using cyclosporine A) with chronic renal injury,the immunosuppressant was converted to sirolimus (SRL).The initial dose of SRL was 4 mg per day and 2 mg at the next day.The blood SRL concentration was determined by using high pressure liquid chromatography.When the valley value of SRL concentration reached a range between 5 to 8μg/L,CNI was withdrawn and MMF (1 g/day) was given simultaneously.The basal values of serum creatinine (Scr),creatinie clearance rate (Ccr) and glomerular filtration rate (GFR) were recorded in the recipients before study,and at 1st,3rd,6th,12th,and 24th month after using SRL,blood SRL concentration,Scr,Ccr and GFR,as well as body weight,blood pressure,blood cells count,liver function (serum bilirubin,albumin and prothrombin time),liver biochemistry (AST,ALT,γ-GT and AKP),blood fat (cholesterol and triglyceride) and urine protein were monitored.At the 12th month after using SRL,the graft liver was biopsied to diagnosis rejection.Results During an average followup period of 29.4 months,there were two deaths.In the remaining 21 cases,the Scr values were (147.40 ± 23.36),(152.60 ± 20.08),(150.20 ± 22.64),( 137.60 ± 18.09) and (138.30 ± 17.04)μmol/L,respectively at 1st,3rd,6th,12th,24th month after using SRL.As compared with basal Scr values [(158.91 ± 29.13) μmol/L],there were statistically significant differences at 1at,12th,24th month (P＜0.05).The Ccr values were (0,97 ± 0.18),(0.99 ± 0.1 4),( 1.00 ± 0.17),(1.07 ±0.29) and (1.14±0.12) ml/s,respectively at 1st,3rd,6th,12th,24th month after using SRL.As compared with basal Ccr value [(0.91 ± 0.14) ml/s],there were statistically significant differences at 1st,12th,24th month (P＜0.05).The GFR values were (0.80 ± 0.15),(0.78 ± 0.11),(0.75 ±0.12),(0.84 ± 0.10) and (0.94 ± 0.13) ml/s,at 1st,3rd,6th,12th,24th month after using SRL.As compared with basal GFR value [(0.71 ± 0.11) ml/s],there were statistically significant differences at 1st,12th,24th month (P＜0.05).The proportion of patients with Scr≤123 μmol/L in 21 cases was 38.1％,33.3 ％,28.6 ％,47.6 ％ and 52.4 ％,respectively at 1 st,12th,24th month (P＜0.05).No rejection cases were observed.Conclusion The immunosuppressant conversion to SRL improves renal function of liver transplantation patients with chronic renal injury,and the conversion cure can not cause rejection.