Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus‐related cirrhosis

Hibi, Taizo; Shinoda, Masahiro; Itano, Osamu; Obara, Hideaki; Kitago, Minoru; Abe, Yuta; Yagi, Hiroshi; Tanaka, Masayuki; Hoshino, Ken; Fujino, Akihiro; Kuroda, Takeshi; Kawa, Shigeyuki; Tanabe, Minoru; Shimazu, Motohide; Kitagawa, Yuko

doi:10.1111/hepr.12486

Cited by 6 publications

(3 citation statements)

References 29 publications

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“…There was no difference in patient or graft survival [61]. Studies using basiliximab showed similar results [62]. In a randomized study of 140 HCV recipients, there was no significant difference in histological HCV recurrence in patients using basiliximab vs standard immunosuppression (41.2 vs 37.5 %) [63].…”

Section: Immunosuppressionmentioning

confidence: 86%

Management of post liver transplantation recurrent hepatitis C infection with directly acting antiviral drugs: a review

2016

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Recurrent HCV infection (rHCV) of the liver allograft following transplantation is universal and is associated with poor graft and patient survival in comparison with other indications. Treatment of rHCV infection in the previous era with pegylated interferon and ribavirin was associated with low sustained virological response (SVR) due to poor tolerability, adverse events and graft rejection. Recently, directly acting antiviral drugs (DAA) have been approved for the treatment of hepatitis C infection and a number of clinical trials have been conducted across various centers in the management of rHCV infection of the graft. In this review we discuss about recent studies that have emerged on the use of NS5b polymerase inhibitor, sofosbuvir in combination with second generation protease inhibitor, simeprevir, fixed dose ledipasvir or daclatasvir with or without ribavirin in the treatment of post transplant rHCV infection.

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Section: Immunosuppressionmentioning

confidence: 86%

Management of post liver transplantation recurrent hepatitis C infection with directly acting antiviral drugs: a review

2016

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“…One possible reason for this is the higher rate of acute rejection in the glucocorticosteroid-free arm, which was treated with glucocorticosteroid pulses. It is possible that with the use of alternative immunosuppression strategies to prevent rejection that glucocorticosteroid-free immunosuppression may lead to lower rates of HCV recurrence (Hibi 2015). Our review identified a number of studies published between 2009 and 2017 in which glucocorticosteroids were replaced with an alternative immunosuppressant.…”

Section: Implications For Researchmentioning

confidence: 99%

Glucocorticosteroid-free versus glucocorticosteroid-containing immunosuppression for liver transplanted patients

Fairfield

Penninga

Powell

et al. 2018

Cochrane Database of Systematic Reviews

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Many of the benefits and harms of glucocorticosteroid avoidance or withdrawal remain uncertain because of the limited number of published randomised clinical trials, limited numbers of participants and outcomes, and high risk of bias in the trials. Glucocorticosteroid avoidance or withdrawal appears to reduce diabetes mellitus and hypertension whilst increasing acute rejection, glucocorticosteroid-resistant rejection, and renal impairment. We could identify no other benefits or harms of glucocorticosteroid avoidance or withdrawal. Glucocorticosteroid avoidance or withdrawal may be of benefit in selected patients, especially those at low risk of rejection and high risk of hypertension or diabetes mellitus. The optimal duration of glucocorticosteroid administration remains unclear. More randomised clinical trials assessing glucocorticosteroid avoidance or withdrawal are needed. These should be large, high-quality trials that minimise the risk of random and systematic error.

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“…Initially, cyclophosphamide (CyA), prednisolone (PSL) and mizoribine (MIZ) were used as the postoperative immunosuppressants, in accordance with the protocol of our facility[4,5], however, for this patient, MIZ was replaced by mycophenolate mofetil (MMF) due to pancytopenia, and CyA was replaced by tacrolimus (FK) due to renal failure. As the patient had jaundice and persistently elevated aspartate transaminase and alanine transaminase levels, a liver biopsy was performed on the 10 th day after transplantation.…”

Section: Case Presentationmentioning

confidence: 99%

Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature

Yokose

Obara

Shinoda

et al. 2019

WJG

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BACKGROUND Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.

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Steroid minimization immunosuppression protocol using basiliximab in adult living donor liver transplantation for hepatitis C virus‐related cirrhosis

Abstract: A steroid minimization protocol with basiliximab in adult LDLT for HCV is safe and affords equivalent rejection rates compared with standard immunosuppression. However, no significant differences are observed with respect to recurrent HCV, patient survival and metabolic complications.

Cited by 6 publications

References 29 publications

Management of post liver transplantation recurrent hepatitis C infection with directly acting antiviral drugs: a review

Management of post liver transplantation recurrent hepatitis C infection with directly acting antiviral drugs: a review

Glucocorticosteroid-free versus glucocorticosteroid-containing immunosuppression for liver transplanted patients

Colon perforation due to antigenemia-negative cytomegalovirus gastroenteritis after liver transplantation: A case report and review of literature

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