刘召波, 武聚山, 林栋栋, 等. PD-1抑制剂用于肝癌肝移植术前治疗的安全性探讨[J]. 器官移植, 2021, 12(4): 445-449. DOI: 10.3969/j.issn.1674-7445.2021.04.011
引用本文: 刘召波, 武聚山, 林栋栋, 等. PD-1抑制剂用于肝癌肝移植术前治疗的安全性探讨[J]. 器官移植, 2021, 12(4): 445-449. DOI: 10.3969/j.issn.1674-7445.2021.04.011
Liu Zhaobo, Wu Jushan, Lin Dongdong, et al. Safety of PD-1 inhibitor in preoperative treatment of liver transplantation for liver cancer[J]. ORGAN TRANSPLANTATION, 2021, 12(4): 445-449. DOI: 10.3969/j.issn.1674-7445.2021.04.011
Citation: Liu Zhaobo, Wu Jushan, Lin Dongdong, et al. Safety of PD-1 inhibitor in preoperative treatment of liver transplantation for liver cancer[J]. ORGAN TRANSPLANTATION, 2021, 12(4): 445-449. DOI: 10.3969/j.issn.1674-7445.2021.04.011

PD-1抑制剂用于肝癌肝移植术前治疗的安全性探讨

Safety of PD-1 inhibitor in preoperative treatment of liver transplantation for liver cancer

  • 摘要:
      目的  探讨程序性细胞死亡蛋白1(PD-1)抑制剂用于原发性肝癌(肝癌)肝移植术前治疗的安全性。
      方法  回顾性分析7例术前应用PD-1抑制剂的肝癌肝移植受者的临床资料,总结受者免疫相关不良反应(irAE)发生情况及预后情况,评估PD-1抑制剂在肝癌肝移植受者中使用的安全性。
      结果  7例肝癌肝移植受者术前使用PD-1抑制剂,使用疗程为1~20个,自停药至手术间隔时间为6~120 d。5例受者发生不同程度的irAE,其中疲乏3例、发热2例、脱发2例、皮疹2例、腹泻1例、恶心1例、心肌炎1例,多数irAE毒性分级为G1~2级,1例发生G5级毒性反应(致死性心肌炎),并导致受者死亡。1例受者于术后7 d发生排斥反应,经糖皮质激素冲击治疗及增加他克莫司剂量后好转。
      结论  PD-1抑制剂可用于肝癌肝移植术前治疗,但应密切注意其irAE及术后排斥反应的发生。

     

    Abstract:
      Objective  To evaluate the safety of programmed cell death protein 1 (PD-1) inhibitor in the treatment of primary liver cancer (liver cancer) before liver transplantation.
      Methods  Clinical data of 7 recipients given with PD-1 inhibitor before liver transplantation for liver cancer were retrospectively analyzed. The incidence of immune-related adverse event (irAE) and clinical prognosis of the recipients were summarized. The safety of PD-1 inhibitor in recipients prior to liver transplantation for liver cancer was evaluated.
      Results  Seven recipients were treated with PD-1 inhibitor with 1-20 courses before liver transplantation for liver cancer. The time interval from drug withdrawal to liver transplantation was 6-120 d. Five recipients suffered from irAE of different degrees, including fatigue in 3 cases, fever in 2 cases, alopecia in 2 cases, rash in 1 case, nausea in 1 case and myocarditis in 1 case, respectively. A majority of these irAE were classified as grade Ⅰ-Ⅱ. One recipient died from grade Ⅴ irAE (fatal myocarditis). One recipient developed rejection at postoperative 7 d, which were mitigated after glucocorticoid pulse therapy combined with increased dosage of tacrolimus.
      Conclusions  PD-1 inhibitor can be applied in preoperative treatment before liver transplantation for liver cancer. Nevertheless, the incidence of irAE and postoperative rejection should be intimately monitored.

     

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