Immunosuppression in liver and intestinal transplantation.
Best Pract Res Clin Gastroenterol
; 54-55: 101767, 2021.
Article
en En
| MEDLINE
| ID: mdl-34874848
ABSTRACT
Immunosuppression handling plays a key role in the early and long-term results of transplantation. The development of multiple immunosuppressive drugs led to numerous clincial trials searching to reach the ideal regimen. Due to heterogeneity of the studied patient cohorts and flaws in many, even randomized controlled, study designs, the answer still stands out. Nowadays triple-drug immunosuppression containing a calcineurin inhibitor (preferentially tacrolimus), an antimetabolite (using mycophenolate moffettil or Azathioprine) and short-term steroids with or without induction therapy (using anti-IL2 receptor blocker or anti-lymphocytic serum) is the preferred option in both liver and intestinal transplantation. This chapter aims, based on a critical review of the definitions of rejection, corticoresistant rejection and standard immunosuppression to give some reflections on how to reach an optimal immunosuppressive status and to conduct trials allowing to draw solid conclusions. Endpoints of future trials should not anymore focus on biopsy proven, acute and chronic, rejection but also on graft and patient survival. Correlation between early- and long-term biologic, immunologic and histopathologic findings will be fundamental to reach in much more patients the status of operational tolerance.
Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Tacrolimus
/
Rechazo de Injerto
Tipo de estudio:
Clinical_trials
Límite:
Humans
Idioma:
En
Revista:
Best Pract Res Clin Gastroenterol
Asunto de la revista:
GASTROENTEROLOGIA
Año:
2021
Tipo del documento:
Article