Immunosuppressive regimens for adult liver transplant recipients in real-life practice: consensus recommendations from an Italian Working Group

It is a well-recognized fact that implementing new guidelines in clinical practice may be difficult; therefore the Italian Society for Organ and Tissue Transplantation (SITO) set out to define practical immunosuppression tools for the management of liver transplantation patients. In 2017, an Italian...

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Bibliographic Details
Published in:Hepatology international 2020-12, Vol.14 (6), p.930-943
Main Authors: Cillo, Umberto, De Carlis, Luciano, Del Gaudio, Massimo, De Simone, Paolo, Fagiuoli, Stefano, Lupo, Francesco, Tisone, Giuseppe, Volpes, Riccardo
Format: Article
Language:English
Subjects:
Algorithms
Clinical medicine
Colorectal Surgery
Etiology
Guidelines
Hepatocellular carcinoma
Hepatology
Immunosuppression
Immunosuppressive agents
Inhibitor drugs
Liver
Liver cancer
Liver transplantation
Liver transplants
Medicine
Medicine & Public Health
Surgery
Targeted cancer therapy
Transplantation
Working groups
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Summary:It is a well-recognized fact that implementing new guidelines in clinical practice may be difficult; therefore the Italian Society for Organ and Tissue Transplantation (SITO) set out to define practical immunosuppression tools for the management of liver transplantation patients. In 2017, an Italian Working Group of liver transplant experts and hepatologists issued a set of consensus statements along with evidence-based recommendations on the use of everolimus after liver transplantation. This article presents the evidence- and consensus-based algorithms developed within the Italian Working Group, which are aimed towards guiding clinicians in the selection of immunosuppressive regimens for the management of adult liver transplant recipients in real-life practice. The liver transplant recipient population, typically managed in clinical practice, was divided into the following categories: (1) standard patients; (2) critically ill patients; (3) patients with a specific etiology; (4) patients with hepatocellular carcinoma; (5) and patients with de novo malignancies. The algorithms are divided into two parts, according to the time from transplantation (0–3 months and > 3 months) and are discussed here along with relevant supporting literature, when available. Ultimately, it is hoped that the evidence- and consensus-based algorithms developed within the Italian Working Group, and presented here, contribute to simplify, personalize, and optimize immunosuppression of liver transplantation recipients in clinical practice.
ISSN:1936-0533
1936-0541
DOI:10.1007/s12072-020-10091-5