Post-liver transplantation medical complications

Moreno, R.; Berenguer, Marina

doi:10.1016/s1665-2681(19)32022-8

Cited by 122 publications

(93 citation statements)

References 37 publications

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“…Liver transplantation is a lifesaving procedure for many patients with end-stage hepatic disease for whom there are no other medical or surgical options. 932 963 diabetes, and hemochromatosis. 966 Procedure-related risk factors for infection include transfusion of >4 units of red blood cells, 896,951 bacterial contamination due to entry into the gastrointestinal tract, 963 surgical incision method, 963 and use of mu romonab-CD3 within the first week after transplantation.…”

Section: Liver Transplantationmentioning

confidence: 99%

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Bratzler

Dellinger

Olsen

et al. 2013

American Journal of Health-System Pharmacy

1,887

1,464

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Section: Liver Transplantationmentioning

confidence: 99%

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Bratzler

Dellinger

Olsen

et al. 2013

American Journal of Health-System Pharmacy

1,887

1,464

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“…Although the incidence of acute rejection has declined over the years as immunosuppressive regimens have developed, other complications associated with the surgical procedure or immunosuppression, such as hepatic artery thrombosis (HAT), biliary tract complications, and infections,14,15 are of concern. Potential problems related to chronic immunosuppression include systemic events (pulmonary, renal, or neurological) and malignancy 14. In addition, recurrence of original diseases such as hepatitis C virus (HCV) infection, hepatocellular carcinoma (HCC), and primary sclerosing cholangitis represents a major clinical obstacle.…”

Section: Introduction To Liver Transplantationmentioning

confidence: 99%

The role of everolimus in liver transplantation

Ganschow¹,

Pollok²,

Jankofsky³

et al. 2014

CEG

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During the last 5 decades, liver transplantation has witnessed rapid development in terms of both technical and pharmacologic advances. Since their discovery, calcineurin inhibitors (CNIs) have remained the standard of care for immunosuppression therapy in liver transplantation, improving both patient and graft survival. However, adverse events, particularly posttransplant nephrotoxicity, associated with long-term CNI use have necessitated the development of alternate treatment approaches. These include combination therapy with a CNI and the inosine monophosphate dehydrogenase inhibitor mycophenolic acid and use of mammalian target of rapamycin (mTOR) inhibitors. Everolimus, a 40-O-(2-hydroxyethyl) derivative of mTOR inhibitor sirolimus, has a distinct pharmacokinetic profile. Several studies have assessed the role of everolimus in liver transplant recipients in combination with CNI reduction or as a CNI withdrawal strategy. The efficacy of everolimus-based immunosuppressive therapy has been demonstrated in both de novo and maintenance liver transplant recipients. A pivotal study in 719 de novo liver transplant recipients formed the basis of the recent approval of everolimus in combination with steroids and reduced-dose tacrolimus in liver transplantation. In this study, everolimus introduced at 30 days posttransplantation in combination with reduced-dose tacrolimus (exposure reduced by 39%) showed comparable efficacy (composite efficacy failure rate of treated biopsy-proven acute rejection, graft loss, or death) and achieved superior renal function as early as month 1 and maintained it over 2 years versus standard exposure tacrolimus. This review provides an overview of the efficacy and safety of everolimus-based regimens in liver transplantation in the de novo and maintenance settings, as well as in special populations such as patients with hepatocellular carcinoma recurrence, hepatitis C virus-positive patients, and pediatric transplant recipients. We also provide an overview of ongoing studies and discuss potential expansion of the role for everolimus in these settings.

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“…Both are better than the rates reported in the previous series (50% to 100%). [1][2][3][17][18][19][20][21] Early diagnosis coupled with aggressive treatment might be possible reasons for this difference.…”

Section: Discussionmentioning

confidence: 99%

“…Infectious conditions, such as cytomegalovirus and nocardiosis, are prevalent in the early posttransplant period, whereas noninfectious conditions, such as posttransplant lymphoproliferative disorder and recurrent tumor, are common in the late posttransplant period. [19][20][21] However, it has been reported that pulmonary nodules occurring in the first to third months post transplant are significantly associated with Aspergillus infection. 12,17-20 This study has several limitations.…”

Section: Discussionmentioning

confidence: 99%