''Minimizing tacrolimus'' strategy and long-term survival after liver transplantation

Jia, Junjun; Lin, Bin-Yi; He, Junyi; Geng, Lei; Kadel, Dhruba; Wang, Li; Yu, Dongdong; Shen, Tian; Yang, Zhe; Ye, Yufu; Zhou, Lin; Zheng, Shusen

doi:10.3748/wjg.v20.i32.11363

Cited by 32 publications

(30 citation statements)

References 26 publications

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“…Survival outcomes after LT have constantly improved using upgraded immunosuppressive agents [165]. However, the inadequate or excessive immunosuppression is associated with a higher risk of rejection, higher incidence of infection, drug toxicity, and increased mortality [166][167][168][169][170]. Experimental studies in rats have investigated the effect of immunosuppressive agents on the intestinal microbiota in LT.…”

Section: Gut Microbiota and Hepatic Ischemia Reperfusion In Liver Surmentioning

confidence: 99%

Current Knowledge about the Effect of Nutritional Status, Supplemented Nutrition Diet, and Gut Microbiota on Hepatic Ischemia-Reperfusion and Regeneration in Liver Surgery

et al. 2020

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Ischemia-reperfusion (I/R) injury is an unresolved problem in liver resection and transplantation. The preexisting nutritional status related to the gut microbial profile might contribute to primary non-function after surgery. Clinical studies evaluating artificial nutrition in liver resection are limited. The optimal nutritional regimen to support regeneration has not yet been exactly defined. However, overnutrition and specific diet factors are crucial for the nonalcoholic or nonalcoholic steatohepatitis liver diseases. Gut-derived microbial products and the activation of innate immunity system and inflammatory response, leading to exacerbation of I/R injury or impaired regeneration after resection. This review summarizes the role of starvation, supplemented nutrition diet, nutritional status, and alterations in microbiota on hepatic I/R and regeneration. We discuss the most updated effects of nutritional interventions, their ability to alter microbiota, some of the controversies, and the suitability of these interventions as potential therapeutic strategies in hepatic resection and transplantation, overall highlighting the relevance of considering the extended criteria liver grafts in the translational liver surgery.

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Section: Gut Microbiota and Hepatic Ischemia Reperfusion In Liver Surmentioning

confidence: 99%

Current Knowledge about the Effect of Nutritional Status, Supplemented Nutrition Diet, and Gut Microbiota on Hepatic Ischemia-Reperfusion and Regeneration in Liver Surgery

et al. 2020

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“…Subsequently, the more effective and less toxic CNI tacrolimus (TAC) was identified in the 1980s [2,3], resulting in lower rejection rates and improving the short-term allograft survival rates. Current 1-year graft survival rates are~90%, and acute rejection rates are below 20% [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Biomarkers for individualized dosage adjustments in immunosuppressive therapy using calcineurin inhibitors after organ transplantation

Tajima

Suetsugu

et al. 2018

Acta Pharmacol Sin

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Calcineurin inhibitors (CNIs), such as cyclosporine A and tacrolimus, are widely used immunosuppressive agents for the prevention of post-transplantation rejection and have improved 1-year graft survival rates by up to 90%. However, CNIs can induce severe reactions, such as acute or chronic allograft nephropathy, hypertension, and neurotoxicity. Because CNIs have varied bioavailabilities, narrow therapeutic ranges, and individual propensities for toxic effects, therapeutic drug monitoring is necessary for all CNIs. Identifying the genetic polymorphisms in drug-metabolizing enzymes will help to determine personalized dosage regimens for CNIs, as CNIs are substrates for CYP3A5 and P-glycoprotein (P-gp, MDR1). CNIs are often concomitantly administered with voriconazole or proton pump inhibitors (PPIs), giving rise to drug interaction problems. Voriconazole and PPIs can increase the blood concentrations of CNIs, and both are primarily metabolized by CYP2C19. Thus, it is expected that interactions between CNIs and voriconazole or PPI would be affected by CYP2C19 and CYP3A5 polymorphisms. CNI-induced acute kidney injury (AKI) is a serious complication of transplantations. Neutrophil gelatinase-associated lipocalin (NGAL) and kidney injury molecule 1 (KIM-1) are noninvasive urinary biomarkers that are believed to be highly sensitive to CNI-induced AKI. In this article, we review the adverse events and pharmacokinetics of CNIs and the biomarkers related to CNIs, including CYP3A5, CYP2C19, MDR1, NGAL, and KIM-1. We hope that these data will help to identify the optimal biomarkers for monitoring CNI-based immunosuppressive therapy after organ transplantation.

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“…Sirolimus significantly reduced tumor recurrence and increased survival for Chinese liver transplant recipients with HCC beyond Milan criteria. Considering this situation, Jia et al 82 established the Hangzhou criteria, which are suitable for Chinese transplant recipients with HCC. Based on this standard, tacrolimus is still a first-choice immunosuppressive agent for patients in the first month after liver transplantation.…”

Section: Special Featuresmentioning

confidence: 99%

Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use

Li¹,

Li²

2015

DDDT

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Tacrolimus is a product of fermentation of Streptomyces, and belongs to the family of calcineurin inhibitors. It is a widely used immunosuppressive drug for preventing solid-organ transplant rejection. Compared to cyclosporine, tacrolimus has greater immunosuppressive potency and a lower incidence of side effects. It has been accepted as first-line treatment after liver and kidney transplantation. Tacrolimus has specific features in Chinese transplant patients; its in vivo pharmacokinetics, treatment regimen, dose and administration, and adverse-effect profile are influenced by multiple factors, such as genetics and the spectrum of primary diseases in the Chinese population. We reviewed the clinical experience of tacrolimus use in Chinese liver- and kidney-transplant patients, including the pharmacology of tacrolimus, the immunosuppressive effects of tacrolimus versus cyclosporine, effects of different factors on tacrolimus metabolism on Chinese patients, personalized medicine, clinical safety profile, and patient satisfaction and adherence. This article provides guidance for the rational and efficient use of tacrolimus in Chinese organ-transplant patients.

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''Minimizing tacrolimus'' strategy and long-term survival after liver transplantation

Abstract: The early ''minimizing tacrolimus'' strategy with a mean TC of 5-10 ng/mL and SD of 2-4 was beneficial in terms of long-term survival after LT.

Cited by 32 publications

References 26 publications

Current Knowledge about the Effect of Nutritional Status, Supplemented Nutrition Diet, and Gut Microbiota on Hepatic Ischemia-Reperfusion and Regeneration in Liver Surgery

Current Knowledge about the Effect of Nutritional Status, Supplemented Nutrition Diet, and Gut Microbiota on Hepatic Ischemia-Reperfusion and Regeneration in Liver Surgery

Biomarkers for individualized dosage adjustments in immunosuppressive therapy using calcineurin inhibitors after organ transplantation

Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use

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''Minimizing tacrolimus'' strategy and long-term survival after liver transplantation

Abstract: The early ''minimizing tacrolimus'' strategy with a mean TC of 5-10 ng/mL and SD of 2-4 was beneficial in terms of long-term survival after LT.

Cited by 32 publications

References 26 publications

Current Knowledge about the Effect of Nutritional Status, Supplemented Nutrition Diet, and Gut Microbiota on Hepatic Ischemia-Reperfusion and Regeneration in Liver Surgery

Current Knowledge about the Effect of Nutritional Status, Supplemented Nutrition Diet, and Gut Microbiota on Hepatic Ischemia-Reperfusion and Regeneration in Liver Surgery

Biomarkers for individualized dosage adjustments in immunosuppressive therapy using calcineurin inhibitors after organ transplantation

Tacrolimus in preventing transplant rejection in&nbsp;Chinese patients &ndash; optimizing use

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Tacrolimus in preventing transplant rejection in Chinese patients – optimizing use