移植应当使用最低剂量的环孢霉素

一项关于肝癌肝移植后肿瘤复发率的最新研究发现：肝癌移植后高剂量的免疫抑制剂环孢霉素的使用会肿瘤复发。这项发现报导于2005年5月的肝脏移植杂志上。

该项研究是由波罗尼亚大学外科和移植系的Marco Vivarelli博士带领的。该研究在1991年至2002年间检查了70位肝移植术后服用环孢霉素最为主要免疫抑制剂药物的患者。环孢霉素的剂量在临床医生的指导下决定的，是以临床和生化指标为基础，而不考虑服药后的血药浓度。在移植手术后的2至40个月间由7位肝细胞癌患者复发。研究员发现肿瘤复发与环孢霉素的血药浓度显著相关，其中两个肿瘤复发患者的血药浓度是较高的。其它诸如性别、潜在的肝脏疾病，或者环孢霉素与其它免疫抑制剂联用等因素都对肿瘤的复发无影响。

由于环孢霉素血药浓度的高低对复发率没有影响，所以研究者建议使用药物安全剂量中的最低剂量。另外，他们还建议应根据患者的肿瘤生物学特点量体裁衣，个性化使用免疫抑制剂，谨记高危患者可能会从最低剂量的环孢霉素中获得益处。

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.