Importance of liver biopsy findings in immunosuppression management: Biopsy monitoring and working criteria for patients with operational tolerance
Makaleler > Derleme · 2012
Yazarlar: Oyedele Adeyi, Graeme Alexander, Leonardo Baiocchi, Manjula Balasubramanian, Ibrahim Batal, Chris O. C. Bellamy, Atul Bhan, Nancy Bridges, John Bucuvalas, Frederic Charlotte, Bob Colvin, Albert Czaja, Anthony Demetris, Michael DeVera, Magda S. El-Monayeri, Sandy Feng, Linda Ferrell, Maria Isabel Fiel, Paulo Fontes, John Fung, Hironori Haga, John Hart, Eva Honsova, Stefan Hubscher, Ismail Wesam, Tomoo Itoh, Nirag Jhala, Patricia Jungmann, Urmila Khettry, Takaaki Koshiba, Charles Lassman, Jan Lerut, Saverio Ligato, John Lunz, George Mazariegos, Geoff McCaughan, Sandra A. McClelland, Marta I. Minervini, Joseph Misdraji, Thalachallour Mohanakumar, Johan Molne, Alexandru Musat, Michael Nalesnik, Imad Nasser, Desley Neil, James Neuberger, Orit Pappo, Lydia Petrovic, Parmjeet Randhawa, Finn P. Reinholt, Erin Rubin, Phil Ruiz, Ozgul Sagol, Alberto Sanchez Fueyo, Eizaburo Sasatomi, Thomas Schiano, Mylene Sebagh, Avi Shaked, Francis Edward Sharkey, Tomokazu Shimizu, Banu Sis, Maxwell Smith, Aurelio Sonzogni, Nadia Tchao, Swan Thung, Giuseppe Tisone, Athanassios Tsamandas, Annika Wernerson, Tong Wu, Funda YILMAZ BARBET
LIVER TRANSPLANTATION, SCI Expanded İndekslerine Giren Dergi, Uluslararası, 2012, cilt 18, ss 1154-1170
DOI: 10.1002/lt.23481
Özet
Obstacles to morbidity-free long-term survival after liver transplantation (LT) include complications of immunosuppression (IS), recurrence of the original disease and malignancies, and unexplained chronic hepatitis and graft fibrosis. Many programs attempt to minimize chronic exposure to IS by reducing dosages and stopping steroids. A few programs have successfully weaned a highly select group of recipients from all IS without apparent adverse consequences, but long-term follow-up is limited. Patients subjected to adjustments in IS are usually followed by serial liver chemistry tests, which are relatively insensitive methods for detecting allograft damage. Protocol biopsy has largely been abandoned for hepatitis C virusnegative recipients, at least in part because of the inability to integrate routine histopathological findings into a rational clinical management algorithm. Recognizing a need to more precisely categorize and determine the clinical significance of findings in long-term biopsy samples, the Banff Working Group on Liver Allograft Pathology has reviewed the literature, pooled the experience of its members, and proposed working definitions for biopsy changes that (1) are conducive to lowering IS and are compatible with operational tolerance (OT) and (2) raise concern for closer follow-up and perhaps increased IS during or after IS weaning. The establishment of guidelines should help us to standardize analyses of the effects of various treatments and/or weaning protocols and more rigorously categorize patients who are assumed to show OT. Long-term follow-up using standardized criteria will help us to determine the consequences of lowering IS and to define and determine the incidence and robustness of OT in liver allografts. Liver Transpl 18:1154-1170, 2012. (c) 2012 AASLD.