The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence
Despite the success of liver transplantation, long-term complications remain, including de novo malignancies, metabolic syndrome, and the recurrence of hepatitis C virus (HCV) and hepatocellular carcinoma (HCC). The current mainstay of treatment, calcineurin inhibitors (CNIs), can also worsen posttr...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Journal of Transplantation |
| Online Access: | http://dx.doi.org/10.1155/2014/845438 |
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| _version_ | 1832550350566981632 |
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| author | Goran B. Klintmalm Björn Nashan |
| author_facet | Goran B. Klintmalm Björn Nashan |
| author_sort | Goran B. Klintmalm |
| collection | DOAJ |
| description | Despite the success of liver transplantation, long-term complications remain, including de novo malignancies, metabolic syndrome, and the recurrence of hepatitis C virus (HCV) and hepatocellular carcinoma (HCC). The current mainstay of treatment, calcineurin inhibitors (CNIs), can also worsen posttransplant renal dysfunction, neurotoxicity, and diabetes. Clearly there is a need for better immunosuppressive agents that maintain similar rates of efficacy and renal function whilst minimizing adverse effects. The mammalian target of rapamycin (mTOR) inhibitors with a mechanism of action that is different from other immunosuppressive agents has the potential to address some of these issues. In this review we surveyed the literature for reports of the use of mTOR inhibitors in adult liver transplantation with respect to renal function, efficacy, safety, neurological symptoms, de novo tumors, and the recurrence of HCC and HCV. The results of our review indicate that mTOR inhibitors are associated with efficacy comparable to CNIs while having benefits on renal function in liver transplantation. We also consider newer dosing schedules that may limit side effects. Finally, we discuss evidence that mTOR inhibitors may have benefits in the oncology setting and in relation to HCV-related allograft fibrosis, metabolic syndrome, and neurotoxicity. |
| format | Article |
| id | doaj-art-4e09c8a9fdc04b57b4cace252b8253d6 |
| institution | Kabale University |
| issn | 2090-0007 2090-0015 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Transplantation |
| spelling | doaj-art-4e09c8a9fdc04b57b4cace252b8253d62025-02-03T06:06:56ZengWileyJournal of Transplantation2090-00072090-00152014-01-01201410.1155/2014/845438845438The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the EvidenceGoran B. Klintmalm0Björn Nashan1Baylor Simmons Transplant Institute, Baylor University Medical Center, 3410 Worth Street, Suite 950, Dallas, TX 75246, USADepartment of Hepatobiliary Surgery and Visceral Transplantation, University Medical Center Eppendorf, Martinistraβe 52, 20246 Hamburg, GermanyDespite the success of liver transplantation, long-term complications remain, including de novo malignancies, metabolic syndrome, and the recurrence of hepatitis C virus (HCV) and hepatocellular carcinoma (HCC). The current mainstay of treatment, calcineurin inhibitors (CNIs), can also worsen posttransplant renal dysfunction, neurotoxicity, and diabetes. Clearly there is a need for better immunosuppressive agents that maintain similar rates of efficacy and renal function whilst minimizing adverse effects. The mammalian target of rapamycin (mTOR) inhibitors with a mechanism of action that is different from other immunosuppressive agents has the potential to address some of these issues. In this review we surveyed the literature for reports of the use of mTOR inhibitors in adult liver transplantation with respect to renal function, efficacy, safety, neurological symptoms, de novo tumors, and the recurrence of HCC and HCV. The results of our review indicate that mTOR inhibitors are associated with efficacy comparable to CNIs while having benefits on renal function in liver transplantation. We also consider newer dosing schedules that may limit side effects. Finally, we discuss evidence that mTOR inhibitors may have benefits in the oncology setting and in relation to HCV-related allograft fibrosis, metabolic syndrome, and neurotoxicity.http://dx.doi.org/10.1155/2014/845438 |
| spellingShingle | Goran B. Klintmalm Björn Nashan The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence Journal of Transplantation |
| title | The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence |
| title_full | The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence |
| title_fullStr | The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence |
| title_full_unstemmed | The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence |
| title_short | The Role of mTOR Inhibitors in Liver Transplantation: Reviewing the Evidence |
| title_sort | role of mtor inhibitors in liver transplantation reviewing the evidence |
| url | http://dx.doi.org/10.1155/2014/845438 |
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