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.
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。