Single-center experience of steroid-free immunosuppressive therapy after liver transplantation for hepatocellular carcinoma patients / 中华器官移植杂志

ABSTRACT

Objective To evaluate the efficacy and safety of using basiliximab in place of a corticosteroid for immunosuppression following liver transplantation for hepatocellular carcinoma (HCC) in Chinese patients.Method The records of 178 patients with HCC who underwent orthotopic liver transplantation from January 2003 to December 2009 were retrospectively reviewed.All patients received immunosuppression therapy that contained either basiliximab (n =78) or steroids (n =100) in addition to tacrolimus and mycophenolate mofetil.Assessments included complications related to liver transplantation,occurrence of steroid side effects,recurrence of HCC,and patient and graft survival.Results A smaller proportion of patients receiving basiliximab than steroids experienced de novo diabetes (38.7％ vs.91.0％,respectively) or long-term de novo diabetes mellitus (4.0％ vs.30.3％,respectively) (both,P＜0.0001).The median overall and disease free survival was similar between basiliximab (50.8 months and 19.6 months,respectively) and steroid treated patients (64.2 months and 23.8 months,respectively).The 5-year overall survival and disease free survival rate was also similar between the basiliximab (42.5％ and 38.9％,respectively) and steroid (50.5％ and 39.2％) groups (all,P＞0.730).However,in patients who met the Milan criteria basiliximab was associated with greater 5 year overall survival rate than steroid therapy (88.9％ vs.57.4％,respectively,P =0.022).Conclusion It revealed that the non-steroid treatment does not increase the incidence of acute rejection but also can decrease the incidence of de novo diabetes in the patients with HCC following liver transplantation and prolong the survival time of patients who met the Milan criteria.