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Updates in Surgery

07-05-2024 | Liver Transplantation | Position Paper

Immunosuppression in liver transplant oncology: position paper of the Italian Board of Experts in Liver Transplantation (I-BELT)

Authors: Umberto Cillo, Amedeo Carraro, Alfonso W. Avolio, Matteo Cescon, Fabrizio Di Benedetto, Valerio Giannelli, Paolo Magistri, Daniele Nicolini, Marco Vivarelli, Jacopo Lanari, The Italian Board of Experts in Liver Transplantation (I-BELT)

Published in: Updates in Surgery

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Abstract

Liver transplant oncology (TO) represents an area of increasing clinical and scientific interest including a heterogeneous group of clinical–pathological settings. Immunosuppressive management after LT is a key factor relevantly impacting result. However, disease-related guidance is still lacking, and many open questions remain in the field. Based on such a substantial lack of solid evidences, the Italian Board of Experts in Liver Transplantation (I-BELT) (a working group including representatives of all national transplant centers), unprecedently promoted a methodologically sound consensus conference on the topic, based on the GRADE approach. The group final recommendations are herein presented and commented. The 18 PICOs and Statements and their levels of evidence and grades of recommendation are reported and grouped into seven areas: (1) risk stratification by histopathological and bio-molecular parameters and role of mTORi post-LT; (2) steroids and HCC recurrence; (3) management of immunosuppression when HCC recurs after LT; (4) mTORi monotherapy; (5) machine perfusion and HCC recurrence after LT; (6) physiopathology of tumor-infiltrating lymphocytes and immunosuppression, the role of inflammation; (7) immunotherapy in liver transplanted patients. The interest in mammalian targets of rapamycin inhibitors (mTORi), for steroid avoidance and the need for a reduction to CNI exposure emerged from the consensus process. A selected list of unmet needs prompting further investigations have also been developed. The so far heterogeneous and granular approach to immunosuppression in oncologic patients deserves greater efforts for a more standardized therapeutic response to the different clinical scenarios. This consensus process makes a first unprecedented step in this direction, to be developed on a larger scale.
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Metadata
Title
Immunosuppression in liver transplant oncology: position paper of the Italian Board of Experts in Liver Transplantation (I-BELT)
Authors
Umberto Cillo
Amedeo Carraro
Alfonso W. Avolio
Matteo Cescon
Fabrizio Di Benedetto
Valerio Giannelli
Paolo Magistri
Daniele Nicolini
Marco Vivarelli
Jacopo Lanari
The Italian Board of Experts in Liver Transplantation (I-BELT)
Publication date
07-05-2024
Publisher
Springer International Publishing
Published in
Updates in Surgery
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI
https://doi.org/10.1007/s13304-024-01845-z