Current status of glucocorticoid usage in solid organ transplantation.

Simin Dashti-Khavidaki, Reza Saidi, Hong Lu
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引用次数: 6

Abstract

Glucocorticoids (GCs) have been the mainstay of immunosuppressive therapy in solid organ transplantation (SOT) for decades, due to their potent effects on innate immunity and tissue protective effects. However, some SOT centers are reluctant to administer GCs long-term because of the various related side effects. This review summarizes the advantages and disadvantages of GCs in SOT. PubMed and Scopus databases were searched from 2011 to April 2021 using search syntaxes covering "transplantation" and "glucocorticoids". GCs are used in transplant recipients, transplant donors, and organ perfusate solution to improve transplant outcomes. In SOT recipients, GCs are administered as induction and maintenance immunosuppressive therapy. GCs are also the cornerstone to treat acute antibody- and T-cell-mediated rejections. Addition of GCs to organ perfusate solution and pretreatment of transplant donors with GCs are recommended by some guidelines and protocols, to reduce ischemia-reperfusion injury peri-transplant. GCs with low bioavailability and high potency for GC receptors, such as budesonide, nanoparticle-mediated targeted delivery of GCs to specific organs, and combination use of dexamethasone with inducers of immune-regulatory cells, are new methods of GC application in SOT patients to reduce side effects or induce immune-tolerance instead of immunosuppression. Various side effects involving different non-targeted organs/tissues, such as bone, cardiovascular, neuromuscular, skin and gastrointestinal tract, have been noted for GCs. There are also potential drug-drug interactions for GCs in SOT patients.

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糖皮质激素在实体器官移植中的应用现状。
几十年来,糖皮质激素(GCs)一直是实体器官移植(SOT)免疫抑制治疗的主要药物,因为它们对先天免疫和组织保护具有强大的作用。然而,由于各种相关的副作用,一些SOT中心不愿意长期使用GCs。本文综述了GCs在SOT中的优缺点。检索PubMed和Scopus数据库,检索时间为2011年至2021年4月,检索语法包括“移植”和“糖皮质激素”。GCs用于移植受者、移植供体和器官灌注液中,以改善移植结果。在SOT接受者中,GCs作为诱导和维持免疫抑制治疗。GCs也是治疗急性抗体和t细胞介导的排斥反应的基础。一些指南和方案建议在器官灌注液中添加GCs,并对移植供体进行GCs预处理,以减少移植周围的缺血再灌注损伤。布地奈德、纳米颗粒介导的GC靶向递送到特定器官、地塞米松与免疫调节细胞诱导剂联合使用等对GC受体具有低生物利用度和高效能的GC是GC应用于SOT患者减少副作用或诱导免疫耐受而非免疫抑制的新方法。GCs的各种副作用涉及不同的非靶向器官/组织,如骨骼、心血管、神经肌肉、皮肤和胃肠道。SOT患者的GCs也存在潜在的药物相互作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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