title: [Immunosuppression after liver transplant, now and in future].
abstract: 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 longterm 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 include 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 bio-marker 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.
authors.affiliation: Transplantcentrum IKEM Praha. patr@ikem.cz
authors.forename: P
authors.initials: P
authors.lastname: Trunečka
mesh_terms: D000961:Antilymphocyte Serum / Q000276:immunology / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D000068338:Everolimus; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008107:Liver Diseases / Q000601:surgery; D017093:Liver Failure / Q000601:surgery*; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D009173:Mycophenolic Acid / Q000627:therapeutic use; D015203:Reproducibility of Results; D020123:Sirolimus / Q000031:analogs & derivatives / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D000068338:Everolimus; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus