Trends of Immunosuppression and Outcomes Following Liver
Transplantation: An Analysis of the United Network for Organ Sharing Registry.
Elaine Y. Cheng and Matthew J. Everly
Clinical Transplants 2014, Chapter 2
Abstract
Advances in immunosuppression (IS) agents and strategies
have resulted in reduced rejection rates and improved survival outcomes after
liver transplantation. The use of induction and maintenance IS agents is both
associated with reductions in acute rejection (AR) risk within the first 6 to
12 months post-transplant and with superior failure-free survival. With the
lowered incidence of allograft losses attributable to rejection, the long-term
sequelae of IS have become the major therapeutic challenge. The long-term use
of calcineurin inhibitors and corticosteroids in maintenance immunotherapy
regimens has been implicated in the development of renal dysfunction,
infections, metabolic derangements, de novo and recurrent malignancies, and the
propagation of hepatitis C virus reinfection.
Our analysis of the United Network for Organ Sharing
registry shows the use of induction and maintenance therapy is each associated
with reductions in AR risk, thereby improving post-transplant survival. The
administration of intensive induction regimens appears to be safe and exhibits
an additive beneficial effect. Therefore, the use of intensive induction
regimens may be warranted to allow for reductions in long-term maintenance IS
to minimize drug toxicities while preserving graft outcomes.
Trends of Immunosuppression and Outcomes Following Liver Transplantation: An Analysis of the United Network for Organ Sharing Registry
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