Inmunosupresión en el trasplante hepático: pautas renoprotectoras

Liver transplant immunosuppression during the COVID-19 pandemic

“…Although immunosuppression in liver transplantation uses the same drugs as those used in other types of solid organ transplantation, it is characterised by a lesser intensity. 34 , 35 , 36 , 37 This particularity allows at certain times for the temporary withdrawal of some of the immunosuppressants that are being used, as in the case of a severe infection, kidney failure, neurological disorders, etc. 34 , 35 As seen, the immune response plays a very important role in COVID-19 and, therefore, the immunosuppressants that are regularly used could be determinants both as promoters and as attenuators of the inflammatory response secondary to the disease.…”

“… 34 , 35 , 36 , 37 This particularity allows at certain times for the temporary withdrawal of some of the immunosuppressants that are being used, as in the case of a severe infection, kidney failure, neurological disorders, etc. 34 , 35 As seen, the immune response plays a very important role in COVID-19 and, therefore, the immunosuppressants that are regularly used could be determinants both as promoters and as attenuators of the inflammatory response secondary to the disease. The few published studies, some of which are better described as simple case reports, suggest neither an increase in the incidence of cases in transplant recipients nor a higher mortality rate than in the general population.…”

“… 36 At present, they are usually used jointly with MMF or everolimus so as to maintain lower plasma levels and prevent undesirable effects. 34 , 35 Cyclosporin A binds to cyclophilin (intracellular receptor) and forms an active complex that inhibits calcineurin phosphatase activity. Calcineurin dephosphorylates the cytoplasmic component of nuclear factor of activated T cells (NFATc) so that it may go to the nucleus and activate the genes involved in IL-2 synthesis.…”

Inmunosupresión en el trasplante hepático en la era covid-19

“…Esta particularidad permite en determinados momentos retirar temporalmente alguno de los inmunosupresores que se estén utilizando, como es el caso de una infección grave, insuficiencia renal, alteraciones neurológicas, etc. 34,35 . Como hemos visto, la respuesta inmunitaria juega un papel muy importante en la enfermedad covid-19, y por tanto, los inmunosupresores habitualmente utilizados podrían ser determinantes tanto como favorecedores de la infección como atenuadores de la respuesta inflamatoria secundaria a la misma.…”

Disfuncion renal crónica postrasplante hepático

“…Por otro lado, los niveles elevados de Bilirrubina (entre 10-30 mg/dL) pueden interferir en las determinaciones bioquímicas de la creatinina sérica. Todo ello conduce con frecuencia a una sobre-estimación de la función renal en los pacientes cirróticos (39).…”