一項(xiàng)關(guān)于肝癌肝移植后腫瘤復(fù)發(fā)率的最新研究發(fā)現(xiàn)：肝癌移植后高劑量的免疫抑制劑環(huán)孢霉素的使用會腫瘤復(fù)發(fā)。這項(xiàng)發(fā)現(xiàn)報(bào)導(dǎo)于2005年5月的肝臟移植雜志上。

該項(xiàng)研究是由波羅尼亞大學(xué)外科和移植系的Marco Vivarelli博士帶領(lǐng)的。該研究在1991年至2002年間檢查了70位肝移植術(shù)后服用環(huán)孢霉素最為主要免疫抑制劑藥物的患者。環(huán)孢霉素的劑量在臨床醫(yī)生的指導(dǎo)下決定的，是以臨床和生化指標(biāo)為基礎(chǔ)，而不考慮服藥后的血藥濃度。在移植手術(shù)后的2至40個(gè)月間由7位肝細(xì)胞癌患者復(fù)發(fā)。研究員發(fā)現(xiàn)腫瘤復(fù)發(fā)與環(huán)孢霉素的血藥濃度顯著相關(guān)，其中兩個(gè)腫瘤復(fù)發(fā)患者的血藥濃度是較高的。其它諸如性別、潛在的肝臟疾病，或者環(huán)孢霉素與其它免疫抑制劑聯(lián)用等因素都對腫瘤的復(fù)發(fā)無影響。

由于環(huán)孢霉素血藥濃度的高低對復(fù)發(fā)率沒有影響，所以研究者建議使用藥物安全劑量中的最低劑量。另外，他們還建議應(yīng)根據(jù)患者的腫瘤生物學(xué)特點(diǎn)量體裁衣，個(gè)性化使用免疫抑制劑，謹(jǐn)記高危患者可能會從最低劑量的環(huán)孢霉素中獲得益處。

Low Levels of Cyclosporine Best in Transplants
 
A new study on the incidence of liver cancer following transplant has found that high levels of the immunosuppressant cyclosporine may lead to tumor recurrence. This finding was reported in the May 2005 issue of Liver Transplantation.

Led by Dr. Marco Vivarelli, of the department of surgery and transplantation at the University of Bologna (Italy; www.unibo.it), the study examined 70 patients who took cyclosporine as the main immunosuppressant following liver transplants between 1991 and 2002. The cyclosporine dosage was determined by the clinician in charge, based on clinical and biochemical indications, but without regard to blood levels achieved by the drug after it was administered. Hepatocellular carcinoma (HCC) recurred in seven of the patients between two and 40 months after transplant. The researchers found that the absence of recurrence was significantly related to blood levels of cyclosporine, which were higher in patients who tumors recurred. Other factors, such as gender, underlying liver disease, or the use of cyclosporine with other immunosuppressants did not affect tumor recurrence.

Since higher and lower levels of cyclosporine did not affect rejection rates, the researchers suggest that minimum dosage levels of the drug can be safely used. In addition, they suggest that immunosuppressive schedules be tailored to individual patients based on the biology of their tumors, keeping in mind that high-risk patients would probably benefit from keeping cyclosporine levels as low as possible.