Asian Liver Transplant Network Clinical Guidelines on Immunosuppression in Liver Transplantation

Abstract

As of December 31, 2015, a total of 8,387 liver transplants have been performed in 67 institutions in Japan. There were 8,066 living-donor transplants and 321 cadaveric-donor transplants 318 from heart-beating donor and 3 from non-heart-beating donor. The annual total of liver transplants in 2015 was 448. The number of liver transplants from living-donor decreased to 391, from 419, in 2014, whereas the number of liver transplants from deceaseddonor exceeded 50 for the first time. The most frequent indication was cholestatic disease, followed by neoplastic disease. As for the graft liver in living-donor cases, right-lobe graft was the most popular 35% .

Efficacy and Safety of Everolimus With Reduced Tacrolimus in Liver Transplant Recipients: 24-month Results From the Pooled Analysis of 2 Randomized Controlled Trials

“…These findings are in line with the recently published clinical guidelines by the Asian Liver Transplant Network that recommended the use of mTORis while reducing the CNI exposure for preservation of renal function in liver transplant patients, and in patients transplanted for HCC, as well as in patients with posttransplant HCC recurrence. 42 The overall safety of EVR + rTAC therapy in this pooled analysis was in line with the known profile, and no unexpected safety concerns were identified. The trend toward numerically lower HCC recurrence seen with EVR + rTAC was more pronounced in patients outside Milan criteria, an important finding that may expand liver transplantation boundaries if confirmed by prospective studies with longer follow-up data.…”

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

“…Nevertheless, transplant centers across the world are increasingly adopting an early IS strategy that includes NDI. Guidelines from the European Association for the Study of the Liver recommend NDI in recipients with renal dysfunction at LT, and the recent guidelines from the Asian Liver Transplant Network advise the administration of NDI in all LT recipients irrespective of pre‐LT renal function . In the United States, the number of LTs performed with NDI over the last decade has nearly doubled, with 21% of US LT centers using NDI in ≥50% of LTs in 2017.…”

The current status and outcomes of pediatric liver transplantation in western China: A multi‐center retrospective study

“…The immunosuppressive regimen evolved over the study period 11 ; in most recipients, immunosuppression was induced using methylprednisolone and maintained using FK506 or cyclosporine, with or without mycophenolate mofetil. Our immunosuppressive regimen involved an initial large dose of methylprednisolone administered early after the operation, with a simultaneous small dose of FK506 or cyclosporine to reduce drug toxicity and protect liver and kidney function until basic liver function had recovered.…”

“…The immunosuppressive regimen evolved over the study period 11 ; in most recipients, immunosuppression was induced using methylprednisolone and maintained using FK506 or cyclosporine, with or without , and the median follow-up period was 5.5 years (range, 0-17.5 years). Table 1 summarizes the characteristics of the study population.…”