| Background:In recent years,with the significant increase in the success rate of liver transplantation,the postoperative survival rate of patients has also increased,but the occurrence of various postoperative adverse reactions,such as rejection,infection and metabolic complications,has seriously affected the quality of life and long-term survival of patients.For a long time,hormone-based immunosuppression has been widely used after liver transplantation,which also indicates that hormone application may be related to the occurrence of the above adverse reactions.With the deepening of the research on the immune response in the field of organ transplantation,basiliximab(Bas),a new immunosuppressant,that can promote immunosuppression by acting on IL-2 receptor to prevent T cell proliferation.It is a monoclonal antibody with high purity,uniform nature and strong specificity.Studies have shown that the complete withdrawal of hormones can be achieved by the induction of Bas after liver transplantation,which to a certain extent can reduce the postoperative infection rate,the recurrence of hepatitis and liver cancer,and protect renal function,which is a clinical concern nowadays.However,due to the small sample size and uneven quality of relevant studies,the credibility of the results has been seriously affected.Therefore,this study systematically evaluated the effectiveness of the hormone-free immunosuppression program induced by Bas after liver transplantation through meta-analysis,providing evidence for clinical application.Objective:To collect and study relevant literatures on hormone-free immunosuppression induced by Bas after liver transplantation,and to systematically evaluate the efficacy of Bas-induced hormone-free immunosuppression after liver transplantation.Methods:CNKI,Wanfang Data,VIP,Pub Med,Embase,Cochrane Library were searched for Chinese and English articles on the efficacy of Bas-induced hormone-free immunosuppressive regimen after liver transplantation published up to December 2020.Two researchers screened the literatures independently in strict accordance with the inclusion and exclusion criteria,and the third researcher evaluated the literatures in case of disagreement.Quality evaluation and information extraction were carried out for the included literature.Rev Man 5.3software was used for statistical analysis,forest map was drawn,and sensitivity analysis was performed.Stata 15.0 software was used to detect row publication bias.Results:1.Literature retrieval results: A total of 315 related literatures were obtained by preliminary retrieval.After eliminating duplicate literatures,there were 293 articles.Finally,10 literatures were included by reading the literature title,abstract,full text to exclude the review,meeting minutes,and the literatures whose experimental intervention did not meet the inclusion criteria,included 6 domestic studies and 4 foreign studies;8 adult studies and 2 children studies,with a total of1152 patients.The NOS scores of the included studies were 6-9.2.Statistical analysis results: the Bas-induced hormone-free immunosuppression regimen could effectively decrease the incidence of postoperative acute rejections[OR=0.68,95% CI(0.48,0.98),P=0.04],total infection rate[OR=0.44,95%CI(0.32,0.62),P< 0.00001],de novo diabetes rate[OR=0.11,95%CI(0.55,0.26),P< 0.00001],metastasis and recurrence rate of liver cancer within one year[OR=0.29,95 % CI(0.16,0.55),P=0.0001],hepatitis B recurrence rate[OR=0.24,95 % CI(0.08,0.76),P=0.02],and the incidence of new-onset hypertension in non-Asian patients [OR=0.22,95%CI(0.08,0.65),P=0.006] after liver transplantation.It can effectively improve the postoperative survival rate of patients [HR=0.48,95%CI(0.36,0.64),P< 0.00001].3.Sensitivity analysis and publication bias results: The sensitivi ty analysis showed that meta-analysis results in this study were stable.Egger method was used to analyze publication bias,and the res ults showed that there was no publication bias.Conclusion:Based on the available data in the published literature,Bas-induced hormone-free immunosuppressive regimen after liver transplantation is more effective and has lower related complicatio ns than the conventional hormonal combination regimen. |
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