Optimization of the use of Calcineurin inhibitors in liver transplantation

被引：28

作者：

de Mare-Bredemeijer, E. L. D. ^{[1
]}

Metselaar, H. J. ^{[1
]}

机构：

[1] Erasmus MC Univ Med Ctr Rotterdam, Dept Gastroenterol & Hepatol, NL-3015 CE Rotterdam, Netherlands

来源：

BEST PRACTICE & RESEARCH CLINICAL GASTROENTEROLOGY | 2012年 / 26卷 / 01期

关键词：

Calcineurin inhibitor; Rend dysfunction; mTOR inhibitor; Minimization; Metabolism; SOLID-ORGAN TRANSPLANTATION; SIROLIMUS-BASED IMMUNOSUPPRESSION; TACROLIMUS-BASED REGIMEN; C VIRUS-REPLICATION; INTERFERON-ALPHA-2B PLUS RIBAVIRIN; ONSET DIABETES-MELLITUS; ONCE-DAILY TACROLIMUS; PROGRAF-BASED REGIMEN; CHRONIC HEPATITIS-C; LOW-DOSE TACROLIMUS;

D O I：

10.1016/j.bpg.2012.01.017

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Calcineurin inhibitors (CNIs), such as cyclosporin A and tacrolimus, are the cornerstone of maintenance immunosuppressive regimens in liver transplantation. CNIs prevent rejection by inhibition of calcineurin, via which lymphocyte proliferation and interleukin (IL)-2 production is prevented. Tacrolimus is now the first-choice immunosuppressant after liver transplantation, since it is associated with fewer episodes of rejection than cyclosporin A. In this review we will discuss interindividual differences, which influence tacrolimus metabolism. Because of these factors and the narrow therapeutic index of tacrolimus, monitoring of drug trough levels is necessary. Furthermore, we will discuss studies concerning conversion from the tacrolimus twice daily to tacrolimus once daily formulation in stable LT patients. Due to adverse effects of CNIs, such as chronic renal failure, hypertension, de novo malignancy and new-onset diabetes mellitus, CNI minimization strategies have been developed, which will be discussed too. (c) 2012 Elsevier Ltd. All rights reserved.

引用

页码：85 / 95

页数：11

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