Selection and use of immunosuppressive therapies after liver transplantation current German practice
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Selection and use of immunosuppressive therapies after liver transplantation current German practice. / Herzer, Kerstin; Strassburg, Christian P; Braun, Felix; Engelmann, Cornelius; Guba, Markus; Lehner, Frank; Nadalin, Silvio; Pascher, Andreas; Scherer, Marcus N; Schnitzbauer, Andreas A; Zimmermann, Tim; Nashan, Björn; Sterneck, Martina.
In: CLIN TRANSPLANT, Vol. 30, No. 5, 05.2016, p. 487-501.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Selection and use of immunosuppressive therapies after liver transplantation current German practice
AU - Herzer, Kerstin
AU - Strassburg, Christian P
AU - Braun, Felix
AU - Engelmann, Cornelius
AU - Guba, Markus
AU - Lehner, Frank
AU - Nadalin, Silvio
AU - Pascher, Andreas
AU - Scherer, Marcus N
AU - Schnitzbauer, Andreas A
AU - Zimmermann, Tim
AU - Nashan, Björn
AU - Sterneck, Martina
N1 - © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2016/5
Y1 - 2016/5
N2 - 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 Apart from patients with autoimmune hepatitis, steroids are withdrawn within 3-6 months after transplantation.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.
AB - 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.
KW - Journal Article
KW - Review
U2 - 10.1111/ctr.12708
DO - 10.1111/ctr.12708
M3 - SCORING: Journal article
C2 - 26855333
VL - 30
SP - 487
EP - 501
JO - CLIN TRANSPLANT
JF - CLIN TRANSPLANT
SN - 0902-0063
IS - 5
ER -
