Current Status of Immunosuppression in Liver Transplantation

Abstract

With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

The effect of liver transplantation on patient-centred outcomes: A propensity-score matched analysis

“…In the early period after transplantation, quality of life is influenced by the surgery itself, any associated complications, and the overall trajectory of recovery [4]. In the longer term, quality of life can clearly be affected by graft failure, disease recurrence, and the complications of immunosuppressive medication, such as infection, malignancy, nephrotoxicity, and cardiovascular complications [5].…”

An Assessment of Publication Status of Pediatric Liver Transplantation Studies

“…Over the years the outcome of pediatric liver transplantation has improved significantly with five year survival rates of 90% and five year long-term graft survival rates of >80% [4, 5]. Thanks to improved surgical techniques, to a better perioperative intensive care-setting and surveillance, and especially due to steadily improved tailored immunosuppressive therapy [6]. Specifically, the use of cyclosporine and tacrolimus were milestones in the development for a better outcome [7].…”

Metabolic Drug Interactions with Immunosuppressants

“…For solid organ transplant recipients, the mainstay of the immunosuppressive regimens is calcineurin inhibitor (CNI) therapy with ciclosporin or tacrolimus which selectively blocks several signaling processes, resulting in the inhibition of T-cell activation and proliferation (Figure 1) [29,30]. These drugs effectively treat allograft rejection; however, they display large interindividual variability in their pharmacokinetics, requiring monitoring of blood concentrations for optimal safety and therapeutic efficacy.…”