肝移植后的急性排斥反应较不常见，但可以预测HBV相关肝细

StephenW

Hepatol Int. 2020 Mar 5. doi: 10.1007/s12072-020-10022-4. [Epub ahead of print]
Acute rejection after liver transplantation is less common, but predicts better prognosis in HBV-related hepatocellular carcinoma patients.
Mao JX1, Guo WY1, Guo M1,2, Liu C1, Teng F3, Ding GS4.
Author information

1
    Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai, China.
2
    National Key Laboratory of Medical Immunology & Institute of Immunology, Navy Medical University, Shanghai, China.
3
    Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai, China. [email protected].
4
    Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai, China. [email protected].

Abstract
BACKGROUND:

With a novel finding of significantly lower incidence of acute rejection (AR) in patients with hepatocellular carcinoma (HCC) after liver transplantation, compared with those with benign end-stage liver disease (BESLD), in a large national cohort, we analyzed the correlations among the perioperative immuno-inflammation status, postoperative AR, and prognosis in HCC and BESLD patients with same etiology of hepatitis B virus (HBV), who underwent liver transplantation.
METHODS:

Patients who underwent liver transplantation due to HBV-related HCC or BESLD and experienced AR between September 2008 and April 2017 were analyzed retrospectively and followed up until April 2018. HCC patients with AR were matched with those without AR according to tumor stage and immunosuppressant concentration, at a 1:3 ratio. Preoperative immuno-inflammation status and prognosis of patients in both groups were compared.
RESULTS:

The overall incidences of AR in patients with HCC and BESLD were 8.60% and 10.61%, respectively. The postoperative 28-day incidence of AR was significantly lower in HCC compared with BESLD patients (3.23% vs 7.08%, p = 0.031). Compared with BESLD patients, the rejection activity index and perioperative CD4/CD8 ratio were significantly lower (p = 0.047 and p < 0.001, respectively), while platelet/lymphocyte ratio was significantly higher in HCC patients (p = 0.041). Later tumor stage in HCC patients was associated with higher systemic immuno-inflammation index, neutrophil/lymphocyte ratio, monocyte/lymphocyte ratio, platelet/lymphocyte ratio, aspartate aminotransferase/lymphocyte ratio, C-reactive protein/albumin ratio and fibrinogen level, and lower CD4/CD8 ratio before transplantation. In HCC patients with AR, the percentage of regulatory T cells (CD4+/CD25+) and the level of IL-10 significantly decreased (p = 0.0023, < 0.0001, respectively), while Th1/Th2 ratio, levels of IFN-γ and IL-2 markedly increased before transplantation (p = 0.0018, 0.0059, 0.0416, respectively). Preoperative monocyte/lymphocyte ratio was an independent risk factor for overall and recurrence-free survival after liver transplantation in HCC patients (p = 0.025, < 0.001, respectively). The 1-, 3-, and 5-year survival rates were 76%, 71% and 53% in the AR group, and 67%, 37% and 25% in the non-AR group (p = 0.042).
CONCLUSION:

Preoperative tumor-related immunosuppression may persist after liver transplantation in HCC patients, and reduce the incidence of AR. AR after liver transplantation may indicate a better prognosis in HCC patients.
KEYWORDS:

Benign end-stage liver disease; Graft rejection; Liver cancer; Perioperative immuno-inflammation status

PMID:
    32140981
DOI:
    10.1007/s12072-020-10022-4

StephenW

Hepatol Int。 2020年3月5日。doi：10.1007 / s12072-020-10022-4。 [Epub提前发行]
肝移植后的急性排斥反应较不常见，但可以预测HBV相关肝细胞癌患者的预后更好。
毛JX1，郭WY1，郭M1,2，刘C1，滕F3，丁GS4。
作者信息

1个
    海军医科大学附属长征医院肝外科和器官移植科，上海
2
    海军医科大学医学免疫学国家重点实验室和免疫学研究所，上海
3
    海军医科大学附属长征医院肝外科和器官移植科，上海[email protected]。
4
    海军医科大学附属长征医院肝外科和器官移植科，上海[email protected]。

抽象
背景：

在一项大型的国家队列研究中，与肝脏良性终末期肝病（BESLD）相比，肝移植后肝细胞癌（HCC）患者的急性排斥（AR）发生率显着降低的新发现，我们分析了相关性肝移植的相同病因的乙肝病毒（HBV）的HCC和BESLD患者的围手术期免疫炎症状态，术后AR和预后
方法：

对2008年9月至2017年4月期间因HBV相关性HCC或BESLD进行肝移植并经历AR的患者进行回顾性分析，并随访至2018年4月。根据肿瘤分期和免疫抑制剂的浓度，将AR的HCC患者与无AR的患者相匹配，以1：3的比例。比较两组患者术前免疫炎症状态和预后。
结果：

HCC和BESLD患者中AR的总发生率分别为8.60％和10.61％。与BESLD患者相比，肝癌术后28天AR发生率显着降低（3.23％对7.08％，p =，0.031）。与BESLD患者相比，HCC患者的排斥活性指数和围手术期CD4 / CD8比值显着降低（分别为p = 0.047和p <0.001），而血小板/淋巴细胞比则明显更高（p = 0.041）。 HCC患者的肿瘤晚期与全身免疫炎症指数，中性粒细胞/淋巴细胞比，单核细胞/淋巴细胞比，血小板/淋巴细胞比，天冬氨酸转氨酶/淋巴细胞比，C反应蛋白/白蛋白比和纤维蛋白原水平较高相关移植前CD4 / CD8比。在患有AR的HCC患者中，调节性T细胞（CD4 + / CD25 +）的百分比和IL-10的水平显着降低（分别为p = 0.0023，<0.0001），而Th1 / Th2比率，IFN-γ和IL的水平移植前-2明显增加（分别为p = 0.0018、0.0059、0.0416）。术前单核细胞/淋巴细胞比率是肝癌患者肝移植术后总体生存和无复发生存的独立危险因素（分别为p = 0.025，<0.001）。 AR组的1年，3年和5年生存率分别为76％，71％和53％，非AR组分别为67％，37％和25％（p = 0.042）。
结论：

肝癌患者肝移植后，术前与肿瘤相关的免疫抑制作用可能会持续，并降低AR的发生率。肝移植后AR可能预示肝癌患者预后较好。
关键字：

良性晚期肝病；接枝排斥肝癌;围手术期免疫炎症状态

PMID：
    32140981
DOI：
    10.1007 / s12072-020-10022-4