Is there such a thing as protocol immunosuppression in liver transplantation?
Is there such a thing as protocol immunosuppression in liver transplantation?
复制标题
肝移植中有免疫抑制方案吗？
DOI：
10.1586/17474124.2014.954550
复制
发表时间：
2015
影响因子：
3.9
通讯作者：
S. Strasser
中科院分区：
文献类型：
--
作者：
G. McCaughan;K. Sze;S. Strasser
肝移植中的方案免疫抑制在很大程度上是一个过时的概念。现在，免疫抑制根据多种因素针对个体患者进行个性化治疗，包括原发性肝病（例如 HCV、肝细胞癌）的潜在病因、肾功能、代谢合并症和患者的免疫状态。这些包括在 HCV 感染和具有主要代谢危险因素的情况下省略皮质类固醇、在肾功能不全的情况下尽量减少钙调神经磷酸酶抑制剂以及在恶性肿瘤患者中使用 mTOR 抑制剂。本社论讨论了此类决策的基础。
Protocol immunosuppression in liver transplantation is largely an outdated concept. Immunosuppression is now personalized to the individual patient on the basis of several factors including underlying etiology of original liver disease (e.g., HCV, hepatocellular carcinoma), renal function, metabolic co-morbidities and the patient’s immunological state. These include omission of corticosteroids in HCV infection and those with major metabolic risk factors, the minimization of calcineurin inhibitors in the presence of renal dysfunction and the use of mTOR inhibitors in patients with malignancy. The basis for such decision-making is discussed in this editorial.