Published online Jun 8, 2015. doi: 10.4254/wjh.v7.i10.1355
Peer-review started: October 21, 2014
First decision: November 27, 2014
Revised: December 23, 2014
Accepted: February 10, 2015
Article in press: February 12, 2015
Published online: June 8, 2015
The optimal level of immunosuppression in solid organ transplantation, in particular for the liver, is a delicate balance between the benefit of preventing rejection and the adverse side effects of immunosuppression. There is uncertainty about when this level is achieved in any individual recipient. Immunosuppression regimens vary between individual centers and changes with time as new agents and data are available. Presently concerns about the adverse side effects of calcineurin inhibitor, the main class of immunosuppressive agents used in liver transplantation (LT), has led to consideration of the use of antibody induction therapies for patients at higher risk of developing adverse side effects. The longevity of the transplanted organ is potentially improved by better management of rejection episodes and special consideration for tailoring of immunosuppression to the individual with viral hepatitis C, hepatocellular carcinoma or pregnancy. This review provides an overview of the current strategies for post LT immunosuppression and discusses modifications to consider for special patient populations.
Core tip: This manuscript is a review on common aspects and principles of immunosuppression in liver transplantation (LT) including new advents. It covers the sections of induction, maintenance and monitoring of immunosuppression and also discusses on immunosuppression in special populations. In this review, it has been tried to be connected with last updates in the field of immunosuppression in LT.