Home > Riviste > Panminerva Medica > Fascicoli precedenti > Panminerva Medica 2009 December;51(4) > Panminerva Medica 2009 December;51(4):215-25

ULTIMO FASCICOLO
 

JOURNAL TOOLS

eTOC
Per abbonarsi PROMO
Sottometti un articolo
Segnala alla tua biblioteca
 

ARTICLE TOOLS

Estratti

 

  THE STATE OF LIVER TRANSPLANTATION 

Panminerva Medica 2009 December;51(4):215-25

Copyright © 2010 EDIZIONI MINERVA MEDICA

lingua: Inglese

Current immunosuppressive approaches in liver transplantation

Iacob S. 1, 2, Cicinnati V. R. 1, Beckebaum S. 1

1 Department of Gastroenterology and Hepatology and Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany; 2 Gastroenterology and Hepatology Center, Fundeni Clinical Institute of Digestive Diseases and Liver Transplantation, Bucharest, Romania


PDF


A significant increase of potent immunosuppressive agents over the last two decades has contributed to improved patient and graft survival after liver transplantation (LT). Numerous ongoing studies aim to determine the most effective immunosuppressive protocols while minimizing drug-related side effects. These protocols often combine several drugs with different mechanisms of action and toxicities allowing dosage adjustment. There is also a trend towards tailored immunosuppressive regimens according to the etiology of liver disease and comorbidities such as renal dysfunction and cardiovascular disease. The introduction of antibody induction therapies and antimetabolites resulted in an increasing number of studies with steroid minimization and calcineurin inhibitor (CNI) reduction protocols. Combined mycophenolate mofetil and minimal dose CNI therapy has shown to be safe and to improve kidney function and cardiovascular risk profile in the majority of studies. Sirolimus (SRL) and everolimus constitute a new class of compounds designated as the mammalian target of rapamycin (mTOR) inhibitors, which exhibit immunosuppressive and antiproliferative effects. There are conflicting results with respect to renal improvement upon switch to mTOR inhibitor therapy with concomitant reduction/elimination of CNI. Further trials will determine whether earlier conversion to mTOR inhibitors enable prevention of CNI-related renal dysfunction. Future results from randomized controlled studies will also show whether SRL can improve recurrence-free survival in patients transplanted for hepatocellular carcinoma.

inizio pagina