Significant improvement in the outcome of HCV-infected transplant recipients by avoiding rapid steroid tapering and potent induction immunosuppression

Berenguer, Marina; Aguilera, Victoria; Prieto, M.; Juan, Fernando San; Rayón, José M.; Benlloch, Salvador; Berenguer, J

doi:10.1016/j.jhep.2006.01.005

Cited by 161 publications

(122 citation statements)

References 22 publications

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“…20 For hepatitis C, role of low dose steroids with slow taper is advocated by some studies [85][86][87] Most centers would continue prolonged low dose steroids in patients transplanted for autoimmune liver diseases. 20 …”

Section: Disease Specific Approachmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

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Section: Disease Specific Approachmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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“…Although the data on increased HCV viral load with steroid bolus is convincing, the effect of steroid maintenance remains controversial. Moreover, a rapid reduction in steroid dosage may be harmful for HCV recurrence [98] . Interestingly, Vivarelli et al [99] reported that it is the way that steroids are administered what impacts the recurrence; in fact while rapid steroids tapering and withdrawal exert a negative effect, low-dose steroid maintenance in the first 24 postoperative months seems to reduce the severity of HCV recurrence, in particular the degree of fibrosis associated with recurrent hepatitis.…”

Section: Post-transplant Immunosuppressionmentioning

confidence: 99%

Strategies to reduce hepatitis C virus recurrence after liver transplantation

Ciria

Pleguezuelo²,

Khorsandi³

et al. 2013

WJH

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Hepatitis C virus (HCV) is a major health problem that leads to chronic hepatitis, cirrhosis and hepatocellular carcinoma, being the most frequent indication for liver transplantation in several countries. Unfortunately, HCV re-infects the liver graft almost invariably following reperfusion, with an accelerated history of recurrence, leading to 10%-30% of patients progressing to cirrhosis within 5 years of transplantation. In this sense, some groups have even advocated for not retransplanting this patients, as lower patient and graft outcomes have been reported. However, the management of HCV recurrence is being optimized and several strategies to reduce post-transplant recurrence could improve outcomes, decrease the rate of re-transplantation and optimize the use of available grafts. Three moments may be the focus of potential actions in order to decrease the impact of viral recurrence: the pretransplant moment, the transplant environment and the post-transplant management. In the pre-transplant setting, it is not well established if reducing the pre transplant viral load affects the risk for HCV progression after transplant. Obviously, antiviral treatment can render the patient HCV RNA negative post transplant but the long-term benefit has not yet been fully established to justify the cost and clinical risk. In the transplant moment, factors as donor age, cold ischemia time, graft steatosis and ischemia/reperfusion injury may lead to a higher and more aggressive viral recurrence. After the transplant, discussion about immunosuppression and the moment to start the treatment (prophylactic, pre-emptive or once-confirmed) together with new antiviral drugs are of interest. This review aims to help clinicians have a global overview of posttransplant HCV recurrence and strategies to reduce its impact on our patients.

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“…While cyclosporin A (CsA) and mycophenolate mofetil (MMF) have antiviral effects in tissue culture and m-TOR antagonists have antifibrotic properties in vivo [8][9][10] , use of corticosteroids has been a matter of debate. Repeated usage of high doses of corticosteroids have been associated with more rapid fibrosis progression and poor longterm outcome of graft hepatitis C [11][12] . Nevertheless, steroid boli therapies are still applied after liver transplantation for hepatitis C, and the molecular mechanisms responsible for the steroid-treatment associated exacerbation of HCV infection are currently unclear.…”

Section: Introductionmentioning

confidence: 99%