Selection and use of immunosuppressive therapies after liver transplantation: current German practice.

Abstract

In recent years, immunosuppression (IS) after liver transplantation (LT) has become increasingly diversified as the choice of agents has expanded and clinicians seek to optimize the balance of immunosuppressive potency with the risk of adverse events in individual patients. Calcineurin inhibitors (CNIs) are the primary agents used for patients undergoing liver transplantation. Other therapeutic agents like interleukin-2 receptor antagonists are not universally administered, but can be considered for the delay or reduction in CNI exposure. An early addition of mycophenolate mofetil (MMF) or the mTOR inhibitor everolimus also allows for the reduction in the CNI dose. To reduce the risk of malignancy, in particular of skin tumors, as well as to prevent the deterioration of renal function, everolimus-based therapy may be advantageous. Apart from patients with autoimmune hepatitis, steroids are withdrawn within 3-6 months after transplantation. Overall, immunosuppression can only be standardized in a limited proportion of patients due to specific clinical requirements and risk factors. Future studies should attempt to refine accurate individualization of the immunosuppressive regimen in specific difficult-to-treat patient subpopulations.

• Authors: Kerstin Herzer, Christian P Strassburg, Felix Braun, Cornelius Engelmann, Markus Guba, Frank Lehner, Silvio Nadalin, Andreas Pascher, Marcus N Scherer, Andreas A Schnitzbauer, Tim Zimmermann, Björn Nashan, Martina Sterneck
• Journal: Clinical transplantation (Clin Transplant) Vol. 30 Issue 5 Pg. 487-501 (05 2016) ISSN: 1399-0012 [Electronic] Denmark
• PMID: 26855333 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't, Review)
• Copyright: © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Chemical References

• Immunosuppressive Agents

Topics

• Graft Rejection (etiology, prevention & control)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Liver Transplantation (adverse effects)
• Practice Patterns, Physicians'