文档介绍：Immunosuppression in Liver Transplantation
Shi-Hui Pan, ., FCCP
Transplant Pharmacist
Center for Liver Diseases & Transplantation
Cedars-Sinai Medical Center
Los Angeles, California
Objectives
Current immunosuppressive drugs
Pharmacotherapy and limitations
Principles of immunosuppression
Individualizing
Tapering (who, when, what, and how)
Immunosuppressive strategies
Sparing, withdrawal, or avoidance
Rejection, disease specific
Liver Transplant Team
Surgeons and hepatologists
Medical consultants
Psychiatrist and social worker
Coordinators, OR, and unit nurses
Pharmacist
Procurement/perfusion specialist
Financial specialist
Dietitian
Research and administrative teams
Challenges in Immunosuppression
1990 Improve short-term survival
acute rejection
infection
2000 Improve long-term survival
chronic rejection
chronic allograft dysfunction
drug induced co-morbidities
Immunosuppressive Agents
1999 Sirolimus (Rapamune); Thymoglobulin
1998 Basiliximab (Simulect)
1997 Daclizumab (Zenapax)
1995 Mycophenolate (CellCept); Neoral
1994 Tacrolimus (Prograf, FK 506)
1986 Muromonab-CD3 (OKT3)
1983 Cyclosporine (Sandimmune)
1981 Anti-thymocyte globulin (Atgam)
1963 Corticosteroid
1962 Azathioprine
Challenges in Graft Survival
Organ
Transplant
Chronic Graft
Dysfunction
Acute
Rejection
Chronic
Rejection
GRAFT
LOSS
short-term
long-term
Immunosuppressive Classes Induction
Polyclonal antibody
Atgam, Thymoglobulin
Monoclonal antibody
OKT3
IL-2R antagonists
(Simulect, Zenapax)
Immunosuppressive Classes Maintenance
Calcineurin inhibitor
Neoral, Prograf
Antimetabolite
Imuran, CellCept
TOR inhibitor
Rapamune
Corticosteroid