Abstract：
OBJECTIVE: Advances in surgical procedures and immunosuppressive therapies have considerably improved the outcomes of patients who have undergone liver transplantation in the past few decades. In 2020, the Italian Liver Transplant Working Group published practice-oriented algorithms for immunosuppressive therapy (IT) in adult liver transplant (LT) recipients. Due to the rapidly evolving LT field, regular updates to the recommendations are required. This review presents a consensus- and evidence-based update of the 2020 recommendations.
METHODS: The Italian Liver Transplant Working Group set out to address new IT issues, which were discussed based on supporting literature and the specialists\' personal experiences. The panel deliberated on and graded each statement before consensus was reached.
RESULTS: A series of consensus statements were formulated and finalized on: (i) oncologic indications for LT; (ii) management of chronic LT rejection; (iii) combined liver-kidney transplantation; (iv) immunosuppression for transplantation with an organ donated after circulatory death; (v) transplantation in the presence of frailty and sarcopenia; and (vi) ABO blood group incompatibility between donor and recipient. Algorithms were updated in the following LT groups: standard patients, critical patients, oncology patients, patients with specific etiology, and patients at high immunologic risk. A steroid-free approach was generally recommended, except for patients with autoimmune liver disease and those at high immunologic risk.
CONCLUSIONS: The updated consensus- and evidence-based 2024 recommendations for immunosuppression regimens in adult patients with ABO-compatible LT address a range of clinical variables that should be considered to optimize the choice of the immunosuppression treatment in clinical practice in Italy.
METHODS: The Italian Liver Transplant Working Group set out to address new IT issues, which were discussed based on supporting literature and the specialists\' personal experiences. The panel deliberated on and graded each statement before consensus was reached.
RESULTS: A series of consensus statements were formulated and finalized on: (i) oncologic indications for LT; (ii) management of chronic LT rejection; (iii) combined liver-kidney transplantation; (iv) immunosuppression for transplantation with an organ donated after circulatory death; (v) transplantation in the presence of frailty and sarcopenia; and (vi) ABO blood group incompatibility between donor and recipient. Algorithms were updated in the following LT groups: standard patients, critical patients, oncology patients, patients with specific etiology, and patients at high immunologic risk. A steroid-free approach was generally recommended, except for patients with autoimmune liver disease and those at high immunologic risk.
CONCLUSIONS: The updated consensus- and evidence-based 2024 recommendations for immunosuppression regimens in adult patients with ABO-compatible LT address a range of clinical variables that should be considered to optimize the choice of the immunosuppression treatment in clinical practice in Italy.
摘要：
目的：在过去的几十年中，外科手术和免疫抑制疗法的进步大大改善了接受肝移植的患者的预后。2020年，意大利肝脏移植工作组发布了针对成人肝移植（LT）受体的免疫抑制治疗（IT）的实践算法。由于快速发展的LT场，需要定期更新建议。这篇综述介绍了2020年建议的基于共识和证据的更新。
方法：意大利肝脏移植工作组着手解决新的IT问题，这是根据支持性文献和专家的个人经历进行讨论的。在达成共识之前，小组对每项声明进行了审议和分级。
结果：制定并最终确定了一系列共识声明：（i）LT的肿瘤学适应症；（ii）慢性LT排斥反应的管理；（iii）肝肾联合移植；（iv）循环死亡后器官捐献的免疫抑制移植；（v）虚弱和肌肉减少症存在的移植；（vi）供体和受体之间的ABO血型不相容。算法在以下LT组中进行了更新：标准患者，危重患者,肿瘤患者,具有特定病因的患者，和高免疫风险的患者。通常建议采用无类固醇的方法，除了自身免疫性肝病患者和高免疫风险患者。
结论：更新的基于共识和证据的2024年关于成人ABO相容性LT患者免疫抑制方案的建议解决了一系列临床变量，应考虑这些变量以优化意大利临床实践中免疫抑制治疗的选择。
方法：意大利肝脏移植工作组着手解决新的IT问题，这是根据支持性文献和专家的个人经历进行讨论的。在达成共识之前，小组对每项声明进行了审议和分级。
结果：制定并最终确定了一系列共识声明：（i）LT的肿瘤学适应症；（ii）慢性LT排斥反应的管理；（iii）肝肾联合移植；（iv）循环死亡后器官捐献的免疫抑制移植；（v）虚弱和肌肉减少症存在的移植；（vi）供体和受体之间的ABO血型不相容。算法在以下LT组中进行了更新：标准患者，危重患者,肿瘤患者,具有特定病因的患者，和高免疫风险的患者。通常建议采用无类固醇的方法，除了自身免疫性肝病患者和高免疫风险患者。
结论：更新的基于共识和证据的2024年关于成人ABO相容性LT患者免疫抑制方案的建议解决了一系列临床变量，应考虑这些变量以优化意大利临床实践中免疫抑制治疗的选择。
