Current strategies for immunosuppression following liver transplantation

Gotthardt, Daniel; Bruns, Helge; Weiss, Karl Heinz; Schemmer, Peter

doi:10.1007/s00423-014-1191-9

Cited by 20 publications

(15 citation statements)

References 61 publications

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“…In a randomized multicenter study, Klintmalm et al [50] concluded that adds to the cost of perioperative care. Antibodies used for induction of immunosuppression in LT are classified into two groups; T-cell depleting and nondepleting [interleukin 2 receptor antagonists (IL 2Ra)] [26] .…”

Section: Non-depleting Antibodiesmentioning

confidence: 99%

Review on immunosuppression in liver transplantation

Moini

Schilsky

Tichy

2015

WJH

199

159

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Section: Non-depleting Antibodiesmentioning

confidence: 99%

Review on immunosuppression in liver transplantation

Moini

Schilsky

Tichy

2015

WJH

199

159

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“…Calcineurin inhibitors (CNIs) have been a cornerstone of immunosuppressive therapy after solid organ transplantation, significantly reducing the risk of graft rejection. CNIs, however, are associated with severe adverse effects, such as renal dysfunction, resulting in the reduction of their short-and long-term use [3,4]. Furthermore, mortality rates are higher in LT recipients with vs. without post-transplant renal dysfunction [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Renal Function in Liver Transplant Recipients After Conversion From Calcineurin Inhibitors to mTOR Inhibitors

et al. 2015

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Background:Renal dysfunction often occurs in liver transplant (LT) recipients receiving calcineurin inhibitor (CNI)-based immunosuppressive regimens, increasing morbidity and mortality rates. Replacement of CNIs by mTOR inhibitorbased immunosuppressive protocols may prevent renal impairment in LT recipients. Material/Methods:Outcomes in patients who underwent LT between 1996 and 2010 at our center and who were switched from CNI-based to mTOR inhibitor-based immunosuppression were retrospectively analyzed. Renal course, hyperlipidemia, and graft rejection were assessed in patients maintained on this CNI-free regimen for at least 24 months. Results:Of the 85 patients switched from CNI-based to mTOR inhibitor-based, CNI-free immunosuppression, 78 met the inclusion criteria. Within the first 6 weeks after switching, the covariable adjusted estimated glomerular filtration rate (eGFR) increased 5.6 mL/min [95% confidence interval 2.6-8.7 mL/min, p<0.001], but there were no further statistically noticeable changes in eGFR. Concentrations of cholesterol and triglycerides increased statistically, noticeable within the first 12 months after drug conversion. Histologically proven graft rejection was observed in 4 patients (5.1%) after conversion. Conclusions:Conversion from CNI-based to CNI-free, mTOR inhibitor-based immunosuppression after LT is safe and can result in significant renal recovery. CNI-free, mTOR inhibitor-based immunosuppression is a potential option for patients with contraindications for CNIs and for LT recipients with rapid reduction in kidney function due to CNIs.

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“…3,4 Crucially, antiviral treatments are reducing viral liver disease, permitting non-alcoholic fatty and alcoholic liver disease, including alcoholic hepatitis in recent years, to emerge as the leading indications for listing. 3,4 Crucially, antiviral treatments are reducing viral liver disease, permitting non-alcoholic fatty and alcoholic liver disease, including alcoholic hepatitis in recent years, to emerge as the leading indications for listing.…”

mentioning

confidence: 99%

The decreasing predictive power of MELD in an era of changing etiology of liver disease

Godfrey

Malik

Lai

et al. 2019

American Journal of Transplantation

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The field of liver transplantation has shifted considerably in the MELD era, including changing allocation, immunosuppression, and liver failure etiologies, as well as better supportive therapies. Our aim was to evaluate the predictive accuracy of the MELD score over time. The United Network for Organ Sharing provided de‐identified data on 120 156 patients listed for liver transplant from 2002‐2016. The ability of the MELD score to predict 90‐day mortality was evaluated by a concordance (C‐) statistic and corroborated with competing risk analysis. The MELD score's concordance with 90‐day mortality has downtrended from 0.80 in 2003 to 0.70 in 2015. While lab MELD scores at listing and transplant climbed in that interval, score at waitlist death remained steady near 35. Listing age increased from 50 to 54 years. HCV‐positive status at listing dropped from 33 to 17%. The concordance of MELD and mortality does not differ with age (>60 = 0.73, <60 = 0.74), but is lower in diseases that are increasing most rapidly—alcoholic liver disease and non‐alcoholic fatty liver disease—and higher in those that are declining, particularly in HCV‐positive patients (HCV positive = 0.77; negative = 0.73). While MELD still predicts mortality, its accuracy has decreased; changing etiology of disease may contribute.

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Current strategies for immunosuppression following liver transplantation

Cited by 20 publications

References 61 publications

Review on immunosuppression in liver transplantation

Review on immunosuppression in liver transplantation

Long-Term Renal Function in Liver Transplant Recipients After Conversion From Calcineurin Inhibitors to mTOR Inhibitors

The decreasing predictive power of MELD in an era of changing etiology of liver disease

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