Clinical efficacy of basiliximab-induced glucose-free corticosteroid immunosuppressive regimen after liver transplantation

Objective:To investigate the clinical efficacy of basiliximabinduced glucosefree 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 glucosefree corticosteroid immunosuppressive regimen using a monoclonal antibody + tacrolimus + mycophenolate mofetil tablets were allocated into the hormonefree 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 followup and survival; (2) comparison of postoperative infection, rejection and biliary stenosis between groups. Followup 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 ±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 chisquare 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 followup and survival: patients between groups were followed up for 9-89 months, with a median time of 45 months. The 1 and 3year overall survival rates were respectively 93.25%, 85.24% in the hormonefree 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 hormonefree 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 antiinfective 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 hormonefree 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 hormonefree 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 basiliximabinduced glucosefree corticosteroid immunosuppressive regimen after liver transplantation is safe and feasible, and it can significantly reduce the incidence of postoperative infection and improve longterm overall survival compared with the conventional glucocorticoid immunosuppressive regimen, but increased postoperative biliary stenosis.