The use of induction agents in liver transplantation

Abstract

Purpose of reviewDespite improvements in early graft survival, late graft loss through chronic rejection and morbidity and mortality as a result of long-term treatment with immunosuppressive medications is a major concern. New drugs have facilitated new treatment protocols with the delayed or reduced application of calcineurin inhibitors or steroid avoidance. This review focuses on recent data concerning the use of induction agents in liver transplantation. Recent findingsClinical studies using induction agents have demonstrated their safety and efficacy, and show promise for a beneficial outcome in liver transplant patients. IL-2 receptor antibodies allow a reduction of maintenance immunosuppression and reduce side effects, such as diabetes or renal impairment. Several studies using IL-2 receptor antibodies have also shown a lower incidence of acute rejection episodes in paediatric patients. Thymoglobulin has been used primarily in hepatitis C-positive patients, and studies have shown a positive effect on virus replication without significant recurrence of hepatitis C. Alemtuzumab has shown promising results regarding acute rejection episodes and renal function in a low-dose calcineurin inhibitor protocol. SummaryThe use of induction agents in liver transplantation is a promising strategy to reduce acute rejection episodes, maintenance immunosuppression, and prevent side effects without affecting patient and graft survival.