Conversion to sirolimus-based immunosuppression in maintenance liver transplantation patients

Morard, Isabelle; Dumortier, Jérôme; Spahr, Laurent; Hadengue, Antoine; Majno, Pietro; Morel, Philippe; Mentha, Gilles; Giostra, Emiliano

doi:10.1002/lt.21116

Cited by 67 publications

(46 citation statements)

References 43 publications

(84 reference statements)

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“…In many transplant centers, sirolimus has been used as monotherapy or in adjunct, for patients who have had adverse effects of calcineurin inhibitors [103] . Also, for patients who have developed non-hepatic malignancies post transplant, some LT centers have switched patients to sirolimus, again, because of its antiangiogenic properties [102,104] . The ongoing phase 3 SILVER study (Immunosuppression in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma) could demonstrate the effect immunosuppression with sirolimus will have with HCC reappearance after undergoing transplantation for this primary hepatic malignancy (Clinical Trials government identifier NCT00355862).…”

Section: Immunosuppression Post Transplant: Mtor Inhibitorsmentioning

confidence: 99%

Hepatocellular carcinoma: A comprehensive review

Waller

Deshpande

Pyrsopoulos

2015

WJH

175

123

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chronic hepatitis B and C infections are most commonly afflicted. Different therapeutic options, including liver resection, transplantation, systemic and local therapy, must be tailored to each patient. Liver transplantation offers leading results to achieve a cure. The Milan criteria is acknowledged as the model to classify the individuals that meet requirements to undergo transplantation. Mean survival remains suboptimal because of long waiting times and limited donor organ resources. Recent debates involve expansion of these criteria to create options for patients with HCC to increase overall survival.

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Section: Immunosuppression Post Transplant: Mtor Inhibitorsmentioning

confidence: 99%

Hepatocellular carcinoma: A comprehensive review

Waller

Deshpande

Pyrsopoulos

2015

WJH

175

123

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“…253,254 Moreover, compared with CNIs, mTORi are associated with a higher incidence of dyslipidemia. 174 On the other hand, the results from several studies suggest a reduced weight gain with mTORi versus CNIs.…”

Section: Metabolic Syndromementioning

confidence: 99%

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

et al. 2017

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Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes. COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant. The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting. 12 Department of Gastroenterology and Hepatology, Erasmus MC, University Hospital Rotterdam, the Netherlands. 13 Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Belgium.14 Abdominal Transplant Surgery, Microbiology and Immunology Department, University Hospitals KU Leuven, Belgium. 15 Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Spain. www.transplantjournal.com S1 S olid organ transplantation has evolved from an experimental procedure to an established treatment option for many types of end-stage organ failure. Both patient and graft outcomes are continuing to improve, and 1-year patient and graft survival currently exceed 80%.1,2 However, survival rates gradually decline over the long term. In kidney transplant, 5-and 10-year graft survival rates in Europe are 77% and 56%, and for liver transplant, 64% and 54% (Figures 1 and 2). 3,4 Although most European countries have seen an increase in both living and deceased donation, transplantation is not available to all who would benefit from the procedure, and there is considerable morbidity and mortality for those listed for transplant.6 Therefore, maximizing long-term graft survival and reducing the need for retransplantation is paramount, not only in improving outcomes for the recipients but also for those awaiting a graft. The improvement in outcomes is predominantly due to reduction in (Transplantation. 2017;101:S1-S41). The authors were approached by Astellas to discuss the practical implementation o...

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“…Concomitantly, the use of immunosuppressant such as cyclosporine A, tacrolimus, everolimus and mycophenolate mofetil has been associated to gingival doi: 10.7243/2053-6623-2-2 overgrowth and stomatitis [35][36][37][38][39]. A multidisciplinary approach is essential to evaluate and diagnose these lesions.…”

Section: Oral Manifestations Of Fungal and Viral Infections In Immunomentioning

confidence: 99%

“…Oral stomatitis in transplanted patients could be associated with type of immunosuppressive medication, viral or Candida albicans. In some cases, replacement or decreasing the dosage of immunosuppressive drugs is necessary [35,36,42].…”

Section: Oral Manifestations Of Fungal and Viral Infections In Immunomentioning

confidence: 99%

Oral health protocol for liver transplant patients

Lins¹,

Bastos²

2014

Transplant Technol

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Chronic liver disease and cirrhosis were the ninth leading cause of death in Brazil in 2011. Infectious complications are major factors for morbidity and mortality in liver transplant recipients. Oral infection is a cause of systemic infection for both liver transplant candidates and recipients. Liver transplant patients are at high risk of oral infection and preventive measures are mandatory. Oral treatment is feasible to the majority of patients awaiting liver transplantation. However, protocols for oral lesions management in liver transplant patients are not established in literature yet. The aim of the present study is to describe an oral health protocol for liver transplant patients based in our 12 years of experience in diagnosing and treating oral disease in the Liver Transplantation Clinic, Federal University of Bahia, Brazil. This protocol was developed by a multidisciplinary team of transplant surgeons, hepatologists, transplant nurses and dentists. All patients are evaluated by the hepatology team that assess liver disease severity and refer them to oral care. The oral assessment is carefully carried out. Additional complementary examinations are necessary to conclude diagnosis and proceed to an individual treatment plan. When oral surgery is necessary, coagulation factors, liver disease severity and the extent of surgical procedure are evaluated for each patient.

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Conversion to sirolimus-based immunosuppression in maintenance liver transplantation patients

Cited by 67 publications

References 43 publications

Hepatocellular carcinoma: A comprehensive review

Hepatocellular carcinoma: A comprehensive review

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

Oral health protocol for liver transplant patients

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