Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Jun 8, 2015; 7(10): 1355-1368
Published online Jun 8, 2015. doi: 10.4254/wjh.v7.i10.1355
Review on immunosuppression in liver transplantation
Maryam Moini, Michael L Schilsky, Eric M Tichy
Maryam Moini, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Shiraz 71935-1311, Iran
Michael L Schilsky, Departments of Medicine (Digestive Diseases) and Surgery (Transplantation and Immunology), Yale University Medical Center, New Haven, CT 06520, United States
Eric M Tichy, Department of Pharmacy, Yale-New Haven Hospital, New Haven, CT 06510, United States
Author contributions: Moini M designed the work, collected data and wrote the paper; Schilsky ML and Tichy EM designed the work, collected data and revised the paper.
Conflict-of-interest: The authors declare that there are no conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Maryam Moini, MD, Associate Professor of Medicine, Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Nemazee Hospital, Zand Street, Shiraz 71935-1311, Iran.
Telephone: +98-71-36281442 Fax: +98-71-36281442
Received: October 21, 2014
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.

Keywords: Liver transplantation, Immunosuppression, Immunosuppression induction, Immunosuppression maintenance

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.