The optimal immunosuppression management to prevent early rejection after liver transplantation: A systematic review of the literature and expert panel recommendations

Abstract

Background:The optimal immunosuppression protocol to prevent early acute cellular rejection (ACR) after liver transplantation (LT) avoiding prolonged hospitalization and early hospital readmission is undefined.Objectives: To identify the most suitable immunosuppression regimen for inclusion in ERAS programs in order to minimize early ACR after LT and to provide expert panel recommendations Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.Methods: Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Studies from January 2000 onward focusing on early ACR were included. Rates of early renal dysfunction and infection were evaluated. CRD42021245586 Results: Thirty-seven studies met inclusion criteria; 23 randomized controlled trials, 14 retrospective or prospective observational comparative or noncomparative studies. Several sources of biases which potentially confound conclusions were identified: heterogeneity in immunosuppression protocols, higher serum tacrolimus levels than currently used in clinical practice, differences in the definition of ACR.

Basiliximab Induction and Postoperative Steroid-free Immunosuppression With Tacrolimus in Pediatric Liver Transplantation: A Randomized Clinical Trial

“…It has been used in adult liver transplant as induction therapy. 18 Previous research in adult liver transplant has shown the use of BSA was associated with reduced incidence of acute rejection, 19 more importantly, the dose of CNIs and steroid can be reduced with BSA induction. A randomized trial has shown that combination of TAC and BAS, steroid-free immunosuppression regimen is related to improved 1-y patient and graft survival as well as reduced incidence of acute rejection in pediatric LT. 6 In our study, we did not observe the beneficial effect of BAS in recipient and graft survival rate, that is probably since none of the recipients who died was cause by rejection-related events.…”