Post-liver transplantation immonusuppression: main principles and modern implementation

Бауыр трансплантациясынан кейінгі иммуносупрессивті ем: басты қағидалар және қазіргі таңдағы қолданылуы
Kakharman Yesmembetov 1, Kulpash Kaliaskarova 1, Zhanat Spatayev 2
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1 Department of Hepatology, Republican Diagnostic Сenter, University Medical Center, Astana, Republic of Kazakhstan
2 Department of Hepatobiliary Surgery and Liver Transplantation, National Scientific Center for Oncology and Transplantology, University Medical Center, Astana, Republic of Kazakhstan
J CLIN MED KAZ, Volume 3, Issue 49, pp. 6-14. https://doi.org/10.23950/1812-2892-JCMK-00340
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ABSTRACT

Liver transplantation is the only radical treatment option for the patients with end-stage liver disease. Immunosuppressive therapy is essential for survival of the liver graft and the recipient. There are several tactics of immunosuppression, majority of them utilising tacrolimus as the mainstay. Prolonged use of immunosuppressive drugs is associated with serious adverse effects. Thus, majority of the transplant-centers use combination of several immunosuppressive agents in order to minimise risk and effects of adverse events.

CITATION

Yesmembetov K, Kaliaskarova K, Spatayev Z. Post-liver transplantation immonusuppression: main principles and modern implementation. Journal of Clinical Medicine of Kazakhstan. 2018;3(49):6-14. https://doi.org/10.23950/1812-2892-JCMK-00340

REFERENCES

  • Groth CG. Forty years of liver transplantation: personal recollections. Transplant Proc. 2008;40(4):1127-9.
  • Starzl TE. The Puzzle People: Memoirs Of A Transplant Surgeon. University of Pittsburgh press. 2003. 370 p.
  • Starzl TE, Klintmalm GB, Porter KA, Iwatsuki S, Schröter GP. Liver transplantation with use of cyclosporin A and prednisone. N Engl J Med. 1981;305(5):266-9.
  • Starzl TE, Todo S, Fung J, Demetris AJ, Venkataramanan R, Jain A: FK 506 for human liver, kidney and pancreas transplantation. Lancet. 2:1000-1004, 1989.
  • Halloran PF. Immunosuppressive drugs for kidney transplantation. N Engl J Med. 2004;351(26):2715-29.
  • Kotru A, Sheperd R, Nadler M, Chapman W, Huddleston C, Lowell J. Combined lung and liver transplantation: the United States experience. Transplantation. 2006;82:144–145.
  • Rasmussen A, Davies HF, Jamieson NV, Evans DB, Calne RY. Combined transplantation of liver and kidney from the same donor protects the kidney from rejection and improves kidney graft survival. Transplantation. 1995;59:919–921.
  • Taylor AL, Watson CJ, Bradley JA. Immunosuppressive agents in solid organ transplantation: Mechanisms of action and therapeutic efficacy. Crit Rev Oncol Hematol. 2005;56:23–46.
  • Francavilla A, Barone M, Todo S, Zeng Q, Porter KA, Starzl TE. Augmentation of rat liver regeneration by FK 506 compared with cyclosporin. Lancet. 1989;2(8674):1248-9.
  • Shibasaki F, Hallin U, Uchino H. Calcineurin as a multifunctional regulator. J Biochem. 2002; 131: 1–15.
  • Staatz CE, Goodman LK, Tett SE. Effect of CYP3A and ABCB1 single nucleotide polymorphisms on the pharmacokinetics and pharmacodynamics of calcineurin inhibitors: Part I. Clin Pharmacokinet. 2010 (3):141-75.
  • Staatz CE, Goodman LK, Tett SE. Effect of CYP3A and ABCB1 single nucleotide polymorphisms on the pharmacokinetics and pharmacodynamics of calcineurin inhibitors: Part II. Clin Pharmacokinet. 2010 (4):207-21.
  • Lennard L, Van Loon JA, Weinshilboum RM. Pharmacogenetics of acute azathioprine toxicity: relationship to thiopurine methyltransferase genetic polymorphism. Clin Pharmacol Therap. 1989; 46: 149–154.
  • Gosio B. Sperimentate su culture pure di bacilli del carbonchio demonstrarano notevole potere antisettica. C R Acad Med Torino. 1893;61:484.
  • Sollinger HW. Mycophenolates in transplantation. Clin Transplant. 2004 Oct;18(5):485-92.
  • Jorge S, Guerra J, Santana A, Mil-Homens C, Prata MM. Mycophenolate mofetil: ten years’ experience of a renal transplant unit. Transplant Proc. 2008;40:700–704. 
  • Herrero JI, Quiroga J, Sangro B, Pardo F, Rotellar F, Alvarez-Cienfuegos J et al. Herpes zoster after liver transplantation: incidence, risk factors, and complications. Liver Transpl. 2004;10:1140–1143.
  • Mita MM, Mita A, Rowinsky EK. The molecular target of rapamycin (mTOR) as a therapeutic target against cancer. Cancer Biol Ther. 2003;2:S169–S177.
  • Lopez M, Clarkson MR, Albin M, Sayegh MH, Najafian N. A novel mechanism of action for anti-thymocyte globulin: induction of CD4+CD25+Foxp3+ regulatory T cells. J Am Soc Nephrol. 2006;17:2844–2853.
  • Ducloux D. Is cyclosporine withdrawal a therapeutic option in renal transplant recipients with chronic allograft dysfunction? Minerva Urol Nefrol. 2003 (1):81-9. Review.
  • Geissler EK, Schlitt HJ. Immunosuppression for liver transplantation. Gut. 2009;58:452–463.
  • Vallhonrat H, Williams WW, Cosimi AB, Tolkoff-Rubin N, Ginns LC, Wain JC et al. In vivo generation of C4d, Bb, iC3b, and SC5b-9 after OKT3 administration in kidney and lung transplant recipients. Transplantation. 1999;67:253–258.
  • Magliocca JF, Knechtle SJ. The evolving role of alemtuzumab (Campath-1H) for immunosuppressive therapy in organ transplantation. Transpl Int. 2006;19:705–714.
  • d’Apice AJ, Becker GJ, Kincaid-Smith P, Mathew TH, Ng J, Hardie IR et al. A prospective randomized trial of low-dose versus high-dose steroids in cadaveric renal transplantation. Transplantation. 1984;37:373–377.
  • Neuberger JM, Mamelok RD, Neuhaus P, Pirenne J, Samuel D, Isoniemi H. et al.; ReSpECT Study Group. Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the ‘ReSpECT’ study. Am J Transplant. 2009; 9(2):327-36.
  • Goralczyk AD, Hauke N, Bari N, Tsui TY, Lorf T, Obed A. Interleukin 2 receptor antagonists for liver transplant recipients: a systematic review and meta-analysis of controlled studies. Hepatology. 2011, 54(2):541-54.
  • Asrani SK, Kim WR, Pedersen RA, Charlton MR, Kremers WK, Therneau TM et al. Daclizumab induction therapy in liver transplant recipients with renal insufficiency. Aliment Pharmacol Ther. 2010, 32(6):776-86.
  • Ramirez CB, Doria C, di Francesco F, Iaria M, Kang Y, Marino IR. Anti-IL2 induction in liver transplantation with 93% rejection-free patient and graft survival at 18 months. J Surg Res. 2007;138:198–204.
  • Eason JD, Nair S, Cohen AJ, Blazek JL, Loss GE Jr. Steroid-free liver transplantation using rabbit antithymocyte globulin and early tacrolimus monotherapy. Transplantation. 2003;75:1396–1399.
  • Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients Annual Report: Transplant Data 1993-2002. US Department of Health and Human Services, Health Resources and Services Administration, Special Programs Bureau, Division of Transplantation; United Network of Organ Sharing; University Renal Research Education Association (Table 9.6) Available from: URL: http://www.ustransplant.org/cgi-bin/ar?p=data_tables_10.htm&y=2003.
  • Wiesner RH, Fung JJ. Present state of immunosuppressive therapy in liver transplant recipients. Liver Transpl. 2011;17 Suppl 3:S1-9.
  • Tzakis AG, Tryphonopoulos P, Kato T, Nishida S, Levi DM, Madariaga JR et al. Preliminary experience with alemtuzumab (Campath-1H) and low-dose tacrolimus immunosuppression in adult liver transplantation. Transplantation. 2004;77:1209– 1214.
  • Chen ZS, He F, Zeng FJ, Jiang JP, Du DF, Liu B. Early steroid withdrawal after liver transplantation for hepatocellular carcinoma. World J Gastroenterol 2007;13:5273-5276.
  • Haddad EM, McAlister VC, Renouf E, Malthaner R, Kjaer MS, Gluud LL. Cyclosporin versus tacrolimus for liver transplanted patients. Cochrane Database Syst Rev. 2006;(4:):CD005161.
  • Muduma G, Saunders R., Odeyemi I., Pollock RF. Systematic Review and Meta-Analysis of Tacrolimus versus Ciclosporin as Primary Immunosuppression After Liver Transplant. PLoS ONE 11(11): e0160421.
  • Levy G., Villamil F., Samuel D., Sanjuan F., Grazi GL, Wu Y et al. Results of lis2t, a multicenter, randomized study comparing cyclosporine microemulsion with C2 monitoring and tacrolimus with C0 monitoring in de novo liver transplantation. Transplantation. 2004; 77: 1632–1638.
  • Zhang XQ, Wang ZW, Fan JW, Li YP, Jiao Z, Gao JW et al. The impact of sulfonylureas on tacrolimus apparent clearance revealed by a population pharmacokinetics analysis in Chinese adult liver-transplant patients. Ther Drug Monit. 2012;34:126– 133.
  • Giannelli V, Rossi M, Giusto M, Lucidi C, Lattanzi B, Ruffa A et al. Conversion from twice-daily to once-daily Tacrolimus administration in liver transplant patient: results of long term follow-up. Eur Rev Med Pharmacol Sci. 2013;17(20): 2718–2720.
  • Adam R, Karam V, Delvart V, Trunečka P, Samuel D, Bechstein WO et al.; European Liver Intestine Transplant Association (ELITA). Improved survival in liver transplant recipients receiving prolonged-release tacrolimus in the European Liver Transplant Registry. Am J Transplant. 2015;15(5):1267-82.
  • Yesmembetov K, Sultanaliyev T, Mukazhanov A, Zhexembayev A, Kuttymuratov G, Spatayev Z et al. Prognosis of Patients Following Liver Transplant From Deceased and Living Donors. Exp Clin Transplant. 2018;16 Suppl 1(Suppl 1):152-153.
  • Barraclough KA, Isbel NM, Johnson DW, Campbell SB, Staatz CE. Once- versus twice-daily tacrolimus: are the formulations truly equivalent? Drugs. 2011;71(12):1561–1577.
  • Fisher RA, Ham JM, Marcos A, Shiffman ML, Luketic VA, Kimball PM et al. A prospective randomized trial of mycophenolate mofetil with neoral or tacrolimus after orthotopic liver transplantation. Transplantation. 1998;66:1616–1621.
  • Barkmann A, Nashan B, Schmidt HH, Boker KH, Emmanouilidis N, Rosenau J et al. Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil. Transplantation. 2000;69:1886–1890.
  • Kaltenborn A, Schrem H. Mycophenolate mofetil in liver transplantation: a review. Ann Transplant, 2013; 18: 685-696.
  • Allison AC, Eugui EM: Mycophenolate mofetil and its mechanisms of action. Immunopharmacology, 2000; 47: 85–118.
  • Gao R, Lu Y, Xin YP, Zhang XH, Wang J, Li YP. The effects of different immunosuppressants on chronic allograft nephropathy by affecting the transforming growth factor-beta and Smads signal pathways. Transplant Proc. 2006;38:2154–2157.
  • Barrera Pulido L, Alamo Martinez JM, Pareja Ciuro F, Gomez Bravo MA, Serrano Diez-Canedo J, Bernal Bellido C et al. Efficacy and safety of mycophenolate mofetil monotherapy in liver transplant patients with renal failure induced by calcineurin inhibitors. Transplant Proc. 2008;40:2985–2987.
  • Chinnakotla S, Davis GL, Vasani S, Kim P, Tomiyama K, Sanchez E. et al. Impact of sirolimus on the recurrence of hepatocellular carcinoma after liver transplantation. Liver Transpl. 2009;15(12):1834–1842.