Immunosuppression after liver transplant, now and in future

Czech version

Authors: P. Trunečka
Authors‘ workplace: Transplantcentrum IKEM Praha, přednosta MU Dr. Pavel Trunečka, CSc.
Published in: Vnitř Lék 2013; 59(8): 671-677
Category:

Overview

The development of immunosuppression has significantly affected the development of liver transplantation and has helped to switch from the experimental method to a standard treatment of life threatening liver conditions. Tacrolimus is the basic immunosuppressant for patients after a liver transplant and thanks to its prolonged-release dosage form, which due to its simplicity and reliability of use, replaces tacrolimus twice daily early after the transplant and in the long‑term administration, will apparently, for a while, defend its position. Other widely used medicines include mycophenolic acid and mTOR inhibitors, sirolimus and everolimus. The induction with antilymphocyte antibodies is used in less than 10% of liver recipients. Only a few new immunosuppresants in this century have passed later stages of clinical studies; the last 2 medicines registered for patients after liver transplantation incude Advagraf (Astellas) and Certican (Novartis). Personalised immunosuppression should respect at least the following basic clinical situations: recipients renal function, hepatitis C virus infection, and hepatocellular carcinoma as the liver transplant indication. The results of immunotolerance biomarker research are necessary for a more successful conduct of protocols minimising immunosuppression and leading to immunotolerance, especially under the efforts of complete withdrawal of immunosupression.

Key words:
liver transplantation –⁠ immunosuppression –⁠ calcineurin inhibitors –⁠ mTOR inhibitors –⁠ viral hepatitis C –⁠ hepatocellular carcinoma

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