Latin American Association for the Study of the Liver (ALEH) guidance on postoperative care after liver transplantation

Annals of Hepatology, Journal Year: 2025, Volume and Issue: unknown, P. 101899 - 101899

Published: March 1, 2025

Liver transplantation (LT) is a well-established therapy for patients with decompensated cirrhosis and early-stage hepatocellular carcinoma. activity varies sharply across Latin American (LATAM) countries due to differences in resources, expertise, funding local attitudes toward organ donation transplantation. This current guidance of postoperative care after LT the first position paper Association Study (ALEH) Special Interest Group (SIG), drawing evidence-based recommendations regarding immediate long-term recipients, taking into consideration their applicability America.

Language: Английский

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MAGMa: Your Comprehensive Tool for Differential Expression Analysis in Mass-Spectrometry Proteomic Data.

bioRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: June 27, 2024

Abstract Proteomics, the study of proteins and their functions, plays a vital role in understanding biological processes. In this study, we sought to address challenges analyzing complex proteomic datasets, where subtle changes protein abundance are difficult detect. Utilizing newly developed tool, M aximal A ggregation G ood signal from Ma ss spectrometric data ( MAGMa ), demonstrated its superior performance accurately identifying true signals while effectively filtering out noise. Here show that strikes balance between sensitivity specificity on benchmarking offering robust solution for various quantitative datasets. These findings advance field by providing researchers with powerful tool uncover abundance, contributing our systems potentially facilitating discovery new therapeutic targets.

Language: Английский

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Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Seminars in Liver Disease, Journal Year: 2024, Volume and Issue: 44(01), P. 079 - 098

Published: Jan. 11, 2024

Liver transplantation (LT) is a highly effective treatment for carefully selected patients with hepatocellular carcinoma (HCC). In this review, we explored the development of LT selection criteria and organ allocation policies, comparing original data to underscore their historical progression into intricate task quantitatively estimating pre- post-LT survivals. We emphasized role biomarkers such as serum alpha-fetoprotein, Des-gamma-carboxy-prothrombin, circulating tumor cells, DNA in predicting patient outcomes. Additionally, examined transplant-associated survival benefits difficulties accurately calculating these benefits. also reviewed recent advancements targeted therapy checkpoint inhibitors advanced, inoperable HCC projected integration HCC. further discussed growing use living donor liver transplants United States compared its outcomes those deceased transplants. Furthermore, progress machine perfusion techniques, which have shown potential improving enlarging pool. These present opportunities enhance survivals, refine criteria, establish new priority metrics, develop innovative bridging downstaging strategies, formulate redesigned strategies treatments.

Language: Английский

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mTOR inhibitor reduces nontumour-related death in liver transplantation for hepatocellular carcinoma

Molecular Biomedicine, Journal Year: 2024, Volume and Issue: 5(1)

Published: March 10, 2024

Abstract Sirolimus is a regularly applied immunosuppressant for patients undergoing liver transplantation (LT) hepatocellular carcinoma (HCC). not only significantly inhibits HCC recurrence but also protects renal function. However, the improvement effect of sirolimus on nontumour-related death in still unknown. The aim our study was to investigate therapeutic deaths. In this study, we retrospectively enrolled 403 LT with from January 1, 2015, December 31, 2018. median follow-up time 47.1 months. were divided into group ( N = 184) and sirolimus-free 219). There no significant differences between survival P 0.054). transplant who exceeded Milan or Hangzhou criteria, achieved higher than 0.005; 0.02). Moreover, multivariate analysis showed that strongly reduced hazard ratio (HR) (HR: 0.42; 95% CI: 0.18–1; 0.05) criteria 0.26; 0.08–0.89; 0.032). increased risk death. conclusion, sirolimus-based immunosuppression can reduce exceed transplantation. addition, finding will further promote application after carcinoma.

Language: Английский

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Therapeutic Approach to Post-Transplant Recurrence of Hepatocellular Carcinoma: Certainties and Open Issues

Cancers, Journal Year: 2023, Volume and Issue: 15(23), P. 5593 - 5593

Published: Nov. 26, 2023

Hepatocellular carcinoma (HCC) is a growing indication for liver transplantation (LT). Careful candidate selection prerequisite to keep post-LT recurrence rates within acceptable percentages. In the pre-LT period, various types of locoregional treatments and/or systemic therapies can be used bridging or downstaging purposes. this context, one factors limiting possibility treatment degree functional impairment. LT subject, no widely accepted indications are available guide disease and heterogeneity exists between transplant centers. Improved function post makes multiple therapeutic strategies theoretically feasible, but patient management complicated by need adjust immunosuppressive therapy assess potential toxicities drug-drug interactions. Finally, there controversy uncertainty about use recently introduced immunotherapeutic drugs, mainly due risk organ rejection. paper, we will review most recent literature on post-transplant HCC recurrence, discussing evidence controversies.

Language: Английский

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Maintenance immunosuppressive therapy in liver transplantation: results from CESIT study, an Italian retrospective cohort study

BMJ Open, Journal Year: 2024, Volume and Issue: 14(11), P. e087373 - e087373

Published: Nov. 1, 2024

Objectives To investigate the use of maintenance immunosuppressive treatments following liver transplantation and to compare their risk–benefit profiles in clinical practice. Design Retrospective multicentrer cohort study. Setting Four Italian regions (Lombardy, Veneto, Lazio, Sardinia). Methods Data were integrated from national transplant information system administrative claims data four regions. All adults who underwent incident between 2009 2019 identified categorised into two groups: cirrhosis or hepatocellular carcinoma (HCC). The trend treatment over years was analysed, effectiveness/safety compared using multivariate Cox models (HR; 95% CI). Main outcome measures Mortality, reject/graft failure, incidence severe infections, cancer, diabetes, major adverse cardiovascular events lipid-modifying agents use. Results study comprised 750 subjects 1159 HCC cohort. Over years, there a decline cyclosporine-CsA, while combination therapy involving tacrolimus with other drugs increased monotherapy. Overall, monotherapy slightly 40% both groups, followed by tacrolimus+mycophenolate (39.5%-cirrhosis; 30.6%-HCC) tacrolimus+molecular target rapamycin inhibitors (mTORi) (8.5%-cirrhosis; 13.3%-HCC). No significant differences emerged profile different tacrolimus-based therapies, except for higher risk mortality under (HR: 2.07; 1.17 3.65). Conclusions highlights shift time postliver therapeutic patterns, favouring mycophenolate mTORi, rather than Moreover, potential association identified. Further research is warranted these findings more deeply optimise strategies recipients.

Language: Английский

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Transplant oncology: Concept, history, and evolution

Elsevier eBooks, Journal Year: 2024, Volume and Issue: unknown, P. 3 - 15

Published: Nov. 15, 2024

Language: Английский

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The long-term effects of multidrug immunosuppressive protocols based on calcineurin inhibitors and conversion to rapamycin on the morphology, apoptosis, and proliferation of rat salivary glands

Pharmacological Reports, Journal Year: 2023, Volume and Issue: 75(5), P. 1240 - 1253

Published: Sept. 2, 2023

Abstract Background The effect of multidrug immunosuppressive protocols on the salivary glands is still unknown. This study aimed to determine influence regimens based calcineurin inhibitors (CNIs) and conversion rapamycin morphology, apoptosis, proliferation rat glands. Methods Male rats received cyclosporin A (CsA), tacrolimus (FK-506), mycophenolate mofetil (MMF), (Rapa), prednisone (Pre) according three-drug protocols: CMP (CsA, MMF, Pre), CMP/R Pre with Rapa), TMP (FK-506, TMP/R Rapa). Morphological immunohistochemical quantitative analyses were performed. Results Structural changes in observed all experimental groups, especially submandibular gland. In glands, percentages collagen fibers TUNEL-, Ki67- PCNA-positive cells higher groups vs. control but lower exception parotid gland group group. Conclusions Long-term administration CNIs triple after monotherapy, causes morphological rats. Immunosuppressive treatment associated an increase accumulation. effects lead decreased fibrosis, proliferation. These may possibly prevent abnormalities resulting from application CNIs.

Language: Английский

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Maintenance immunosuppressive therapy in liver transplantation: results from CESIT study, an Italian retrospective cohort study

Research Square (Research Square), Journal Year: 2023, Volume and Issue: unknown

Published: Oct. 23, 2023

Introduction Post-liver transplantation immunosuppressive therapy typically involves the combination of various drugs: calcineurin inhibitors (tacrolimus-TAC or cyclosporine-CsA), with potential addition mycophenolate-MMF mTOR with/without corticosteroids. This study aimed to investigate use treatments and compare their risk-benefit profiles in clinical practice. Methods retrospective multicenter cohort integrated data from national transplant information system administrative claims 4 Italian regions. All adult patients who underwent incident liver between 2009 2019 were identified categorized into two groups: cirrhosis hepatocellular carcinoma-HCC. The trend treatment over years was analyzed, effectiveness/safety compared using multivariate Cox models (HR;95%CI). Results comprised 785 subjects 1,196 HCC cohort. Over years, there a decline CsA, while involving TAC other drugs increased monotherapy. Overall, TAC-monotherapy slightly 40% both groups, followed by TAC+MMF (39.5%-cirrhosis; 30.6%-HCC) TAC+mTORi (8.5%-cirrhosis; 13.3%-HCC). No significant differences emerged profile different TAC-based therapies, except for higher risk mortality under (HR: 2.07;1.17-3.65). Conclusions highlights shift time post-liver therapeutic patterns, favoring MMF mTORi, rather than Moreover, association identified. Further research is warranted optimize strategies recipients.

Language: Английский

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