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Immunosuppression in Liver Transplantation: State of the Art and Future Perspectives.
Curr Pharm Des. 2020 Jun 10 [Online ahead of print]CP

Abstract

BACKGROUND

Novel drugs and combinations for immunosuppression (IS) after liver transplantation is one main reason of improved graft and patient survival seen in the last decades. The backbone of IS are still steroids and calcineurin inhibitors, although novel drugs are being introduced such as mammalian target of rapamycin inhibitors (mTOR inibitor). The challenge today along with increased patient survival is the adverse effects of long-term use of immunosuppressive drugs, mainly nephrotoxicity and other serious adverse effects. Concepts: The ultimate0 outcome after liver transplantation would be achieving tolerance, a state where all IS can be withdrawn. In the meantime, different approaches to reduce and withdraw IS have been tested out in different clinical trials with the aim to reduce the adverse effects of steroids and calcineurin inhibitors. This has formed the basis of today's clinical practice. The different combinations of immunosuppressive drugs have included mTOR inhibitor such as everolimus, and different induction drugs such as anti-interleukin 2 receptor antibodies. Regarding induction drugs, lymphocyte depleting (alemtuzumab and ATG) and non-depleting agents, such as basiliximab have shown advantageous effects.

SUMMARY

Alongside steroid and calcineurin inhibitors reduction or elimination, current strategies for post-liver transplantation immunosuppression explore combinations of novel agents. The gauge (or yardstick) here is the fine balance between adverse effects of IS drugs and risk of rejection. Long-term maintenance IS regimens, development of tolerance and antibody-mediated rejection are also discussed in this review.

Authors+Show Affiliations

Department of Digestive Surgery, University Hospital Northern Norway, University of Tromso. Norway.Department of Gastroenterology, Universidade do Vale do Taquari - Univates -, Lajeado. Brazil.Liver and Pancreas Transplant and Hepatobiliary Surgery Unit, Hospital de Clinicas de Porto Alegre, Medical School of UFRGS, Porto Alegre. Brazil.Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet. Norway.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32520679

Citation

Nedredal, Geir I., et al. "Immunosuppression in Liver Transplantation: State of the Art and Future Perspectives." Current Pharmaceutical Design, 2020.
Nedredal GI, Picon RV, Chedid MF, et al. Immunosuppression in Liver Transplantation: State of the Art and Future Perspectives. Curr Pharm Des. 2020.
Nedredal, G. I., Picon, R. V., Chedid, M. F., & Foss, A. (2020). Immunosuppression in Liver Transplantation: State of the Art and Future Perspectives. Current Pharmaceutical Design. https://doi.org/10.2174/1381612826666200610183608
Nedredal GI, et al. Immunosuppression in Liver Transplantation: State of the Art and Future Perspectives. Curr Pharm Des. 2020 Jun 10; PubMed PMID: 32520679.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Immunosuppression in Liver Transplantation: State of the Art and Future Perspectives. AU - Nedredal,Geir I, AU - Picon,Rafael V, AU - Chedid,Marcio F, AU - Foss,Aksel, Y1 - 2020/06/10/ PY - 2020/04/24/received PY - 2020/05/27/revised PY - 2020/06/01/accepted PY - 2020/6/11/entrez PY - 2020/6/11/pubmed PY - 2020/6/11/medline KW - and alemtuzumab KW - calcineurin Inhibitors KW - glucocorticoids KW - immunomodulation KW - immunosuppression KW - liver transplantation KW - thymoglobulin KW - transplantation tolerance JF - Current pharmaceutical design JO - Curr. Pharm. Des. N2 - BACKGROUND: Novel drugs and combinations for immunosuppression (IS) after liver transplantation is one main reason of improved graft and patient survival seen in the last decades. The backbone of IS are still steroids and calcineurin inhibitors, although novel drugs are being introduced such as mammalian target of rapamycin inhibitors (mTOR inibitor). The challenge today along with increased patient survival is the adverse effects of long-term use of immunosuppressive drugs, mainly nephrotoxicity and other serious adverse effects. Concepts: The ultimate0 outcome after liver transplantation would be achieving tolerance, a state where all IS can be withdrawn. In the meantime, different approaches to reduce and withdraw IS have been tested out in different clinical trials with the aim to reduce the adverse effects of steroids and calcineurin inhibitors. This has formed the basis of today's clinical practice. The different combinations of immunosuppressive drugs have included mTOR inhibitor such as everolimus, and different induction drugs such as anti-interleukin 2 receptor antibodies. Regarding induction drugs, lymphocyte depleting (alemtuzumab and ATG) and non-depleting agents, such as basiliximab have shown advantageous effects. SUMMARY: Alongside steroid and calcineurin inhibitors reduction or elimination, current strategies for post-liver transplantation immunosuppression explore combinations of novel agents. The gauge (or yardstick) here is the fine balance between adverse effects of IS drugs and risk of rejection. Long-term maintenance IS regimens, development of tolerance and antibody-mediated rejection are also discussed in this review. SN - 1873-4286 UR - https://www.unboundmedicine.com/medline/citation/32520679/Immunosuppression_in_Liver_Transplantation:_State_of_the_Art_and_Future_Perspectives L2 - http://www.eurekaselect.com/182692/article DB - PRIME DP - Unbound Medicine ER -
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