We Asked the Experts: Toward Personalized Immunosuppression for Liver Transplant Recipients

Lew, Joey; Perito, Emily R.; Feng, Sandy

doi:10.1007/s00268-021-06417-5

Cited by 2 publications

(4 citation statements)

References 8 publications

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“…The optimal management of immunosuppression drives optimal health after LT, avoiding both graft and systemic complications [ 100 ], ensuring patient and graft survival. Usually, the number and dosage of drugs are reduced over time, having as a goal in one hand, the normality of liver function tests and the low risk of allograft rejection, and in the other hand, the reduction of declining renal function, recurrent infections, de novo malignancy, and other toxicities due to excessive immunosuppression.…”

Section: Immunosuppression In Ltmentioning

confidence: 99%

Bacterial and Viral Infections in Liver Transplantation: New Insights from Clinical and Surgical Perspectives

et al. 2022

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End-stage liver disease patients undergoing liver transplantation are prone to develop numerous infectious complications because of immunosuppression, surgical interventions, and malnutrition. Infections in transplant recipients account for the main cause of mortality and morbidity with rates of up to 80%. The challenges faced in the early post-transplant period tend to be linked to transplant procedures and nosocomial infections commonly in bloodstream, surgical, and intra-abdominal sites. Viral infections represent an additional complication of immunosuppression; they can be donor-derived, reactivated from a latent virus, nosocomial or community-acquired. Bacterial and viral infections in solid organ transplantation are managed by prophylaxis, multi-drug resistant screening, risk assessment, vaccination, infection control and antimicrobial stewardship. The aim of this review was to discuss the epidemiology of bacterial and viral infections in liver transplants, infection control issues, as well as surgical frontiers of ex situ liver perfusion.

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Section: Immunosuppression In Ltmentioning

confidence: 99%

Bacterial and Viral Infections in Liver Transplantation: New Insights from Clinical and Surgical Perspectives

et al. 2022

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“…26 Over the course of establishing a personalized immunosuppressive therapy in the last decade, risk-adjusted tapering and individualization of IS have been introduced. 6,27,28 The aim of the present study was to answer the question to what extent these changes influence the incidence, severity, and clinical course of CMV infection.…”

Section: Introductionmentioning

confidence: 99%

“…5 However, there is consensus, that IS must be highly individualized based on the unique individual risk profile of each patients, including the underlying disease, various comorbidities, immunological factors as well as personal tolerance. 6,7 Although in the past, focus of IS was solely on prevention of acute or chronic rejection, with increasing life-expectancy after LT, clinical evaluation of long-term side effects of pharmacological therapy became more important. [8][9][10][11][12] Furthermore, the association of de novo malignancies in LT patients compared to the general population and the association to IS has been well established.…”

Section: Introductionmentioning

confidence: 99%

“…Although substances and regimens have changed over time, calcineurin inhibitors (CNI), mycophenolate mofetil (MMF), mammalian target of rapamycin inhibitors (mTORI), and glucocorticoids (GC) were established as the standard of care in most centers around the globe 5 . However, there is consensus, that IS must be highly individualized based on the unique individual risk profile of each patients, including the underlying disease, various comorbidities, immunological factors as well as personal tolerance 6,7 …”

Section: Introductionmentioning

confidence: 99%

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Detrimental impact of immunosuppressive burden on clinical course in patients with Cytomegalovirus infection after liver transplantation

Ossami Saidy,

Kollar,

Czigany

et al. 2023

Transplant Infectious Dis

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IntroductionCytomegalovirus (CMV)‐infection and reactivation remain a relevant complication after liver transplantation (LT). The recipient and donor serum CMV‐IgG‐status has been established for risk stratification when choosing various pharmaceutical regimens for CMV‐prophylaxis in the last two decades. However, factors influencing course of CMV‐infection in LT remain largely unknown. In this study, the impact of immunosuppressive regimen was examined in a large cohort of patients.MethodsAll patients that underwent primary LT between 2006 and 2018 at the Charité–Universitaetsmedizin, Berlin, were included. Clinical course as well as histological and laboratory findings of patients were analyzed our prospectively maintained database. Univariate and multivariate regression analysis for impact of variables on CMV‐occurrence was conducted, and survival was examined using Kaplan–Meier analysis.ResultsOverall, 867 patients were included in the final analysis. CMV‐infection was diagnosed in 325 (37.5%) patients after transplantation. Significantly improved overall survival was observed in these patients (Log rank = 0.03). As shown by correlation and regression tree classification and regression tree analysis, the recipient/donor CMV‐IgG‐status with either positivity had the largest influence on CMV‐occurrence. Analysis of immunosuppressive burden did not reveal statistical impact on CMV‐infection, but statistically significant inverse correlation of cumulative tacrolimus trough levels and survival was found (Log rank < .001). Multivariate analysis confirmed these findings (p = .02).DiscussionCMV‐infection remains of clinical importance after LT. Undergone CMV‐infection of either recipient or donor requires prophylactic treatment. Additionally, we found a highly significant, dosage‐dependent impact of immunosuppression (IS) on long‐term outcomes for these patients, underlying the importance of minimization of IS in liver transplant recipients. image

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We Asked the Experts: Toward Personalized Immunosuppression for Liver Transplant Recipients

Abstract: Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Cited by 2 publications

References 8 publications

Bacterial and Viral Infections in Liver Transplantation: New Insights from Clinical and Surgical Perspectives

Bacterial and Viral Infections in Liver Transplantation: New Insights from Clinical and Surgical Perspectives

Detrimental impact of immunosuppressive burden on clinical course in patients with Cytomegalovirus infection after liver transplantation

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