Individualized Immunosuppressive Protocol of Liver Transplant Recipient Should be Made Based on Splenic Function Status / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Lymphocyte subsets play important roles in rejection in liver transplant recipients, and the effect of splenic function on these roles remains unknown. The aim of this study was to explore the feasibility to adjust immunosuppressive agents based on splenic function status through detecting the lymphocyte subsets in liver transplantBeijing recipients.</p><p><b>METHODS</b>The lymphocyte subsets of 49 liver transplant recipients were assessed in the 309th Hospital of Chinese People's Liberation Army between June 2014 and August 2015. The patients were divided into splenectomy group (n = 9), normal splenic function group (n = 24), and hypersplenism group (n = 16). The percentages and counts of CD4+ T, CD8+ T, natural killer (NK) cell, B-cell, regulatory B-cell (Breg), and regulatory T-cell (Treg) were detected by flow cytometer. In addition, the immunosuppressive agents, histories of rejection and infection, and postoperative time of the patients were compared among the three groups.</p><p><b>RESULTS</b>There was no significant difference of clinical characteristics among the three groups. The percentage of CD19+CD24+CD38+ Breg was significantly higher in hypersplenism group than normal splenic function group and splenectomy group (3.29 ± 0.97% vs. 2.12 ± 1.08% and 1.90 ± 0.99%, P = 0.001). The same result was found in CD4+CD25+FoxP3+ Treg percentage (0.97 ± 0.39% vs. 0.54 ± 0.31% and 0.56 ± 0.28%, P = 0.001). The counts of CD8+ T-cell, CD4+ T-cell, and NK cell were significantly lower in hypersplenism group than normal splenic function group (254.25 ± 149.08 vs. 476.96 ± 225.52, P= 0.002; 301.69 ± 154.39 vs. 532.50 ± 194.42, P= 0.000; and 88.56 ± 63.15 vs. 188.33 ± 134.51, P = 0.048). Moreover, the counts of CD4+ T-cell and NK cell were significantly lower in hypersplenism group than splenectomy group (301.69 ± 154.39 vs. 491.89 ± 132.31, P= 0.033; and 88.56 ± 63.15 vs. 226.00 ± 168.85, P = 0.032).</p><p><b>CONCLUSION</b>Splenic function status might affect the immunity of liver transplant recipients, that should be considered when we make immunosuppressive protocols.</p>

Effect of conversion to sirolimus-based immunosuppression on tumor recurrence after liver transplantation for hepatocellular carcinoma beyond the Standard Milan Criteria / 第二军医大学学报

Objective To investigate the effect of sirolimus (SRL)-based immunosuppression regimen on the survival and tumor recurrence in liver transplantation recipients with hepatocellular carcinoma beyond the standard Milan criteria. Methods We retrospectively analyzed 22 patients who received liver transplant in our hospital for HCC beyond the standard Milan criteria from June 2010 to June 2011. Eleven patients received tacrolimus for immunosuppression after liver transplant and the other 11 were converted from tacrolimus to SRL-based immunosuppression. The incidence rate of acute rejection, tumor-free survival period, blood routine, liver function and complications were compared between the two groups. Results The incidence rates of acute rejection were not significantly different between the two groups after a mean follow-up of (12 + 3) months (range, 7-18 months). Four patients in the SRL group and eight patients in tacrolimus group had HCC recurrence and metastasis. Kaplan-Meier recurrence-free survival curves demonstrated that SRL group had a significantly longer HCC recurrence-free survival than tacrolimus group(P<0. 05). Compared with tacrolimus group, SRL group had significantly lower leukocyte and platelet counts (P<0. 05). The tacrolimus-related nephrotoxicity was modestly improved in all the three patients after converted to SRL. Two patients suffered oral ulcers after conversion to SRL treatment and no severe complications such as arterial thrombosis were observed. Conclusion SRL can be effectively used for liver transplant recipients with hepatocellular carcinoma beyond the standard Milan criteria; it can achieve a similar anti-rejection effect to tacrolimus and can greatly reduce tumor recurrence.