Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jul-Dec;9(2):96-101.
doi: 10.5005/jp-journals-10018-1301.

Update on Immunosuppression in Liver Transplantation

Burcak E Tasdogan  1 , Michelle Ma  1 , Cem Simsek  1 , Behnam Saberi  2 , Ahmet Gurakar  1
Affiliations
Review

Update on Immunosuppression in Liver Transplantation

Burcak E Tasdogan et al. Euroasian J Hepatogastroenterol. 2019 Jul-Dec.

Abstract

The standard therapy for decompensated end-stage chronic liver disease of any etiology and acute fulminant hepatic failure is liver transplantation (LT). Advances in immunosuppressive therapy decreased the rates of acute and chronic rejections. Thus, graft and patient survivals have significantly improved. However, long-term adverse effects of prolonged use of immunosuppressive agents such as malignancies, opportunistic infections, metabolic disorders, and other organ toxicities have now become a major concern. Consequently, alternative approaches are needed to deescalate the customary drugs and their side effects. Therapy must be individualized and additional preventive measures should be taken by patients with particular risk factors or predisposed to certain adverse effects. Current opinion favors a combination of agents with different mechanism of actions and toxicity profiles. Corticosteroids are employed in immediate and early postoperative period. Although they have a pronounced side effect profile, calcineurin inhibitors (CNIs) are still the backbone of early and late phase immunosuppressive regimens because of their proved efficacy. Antimetabolites are frequent choices for steroid and/or CNI-sparing strategies. Studies also have established a role for mammalian target of rapamycin (mTOR) inhibitors in specific groups of recipients. Biologic agents are a hot topic of interest and made their way into current strategies for induction. Agents extrapolated from other transplantation or immunologic experience are being evaluated.

How to cite this article: Tasdogan BE, Ma M, Simsek C, et al. Update on Immunosuppression in Liver Transplantation. Euroasian J Hepato-Gastroenterol 2019;9(2):96-101.

Keywords: Adverse effects; Immunosuppression; Liver transplantation.

PubMed Disclaimer

Conflict of interest statement

Source of support: Nil Conflict of interest: None

Figures

Fig. 1
Fig. 1
Timeline of drug discovery illustrating the progression of immunosuppressive therapy in liver transplantation (Timeline of Historical Events and Significant Milestones. Retrieved March 06, 2018, from https://organdonor.gov/about/facts-terms/history.html)
Fig. 2
Fig. 2
The mechanisms of actions of various immunosuppressive agents. ATG, antithymocyte globulin; CNI, calcineurin inhibitors
See this image and copyright information in PMC

References

    1. Starzl TE, Iwatsuki S, Van Thiel DH, et al. Evolution of liver transplantation. Hepatology. 1982;2(5):614–636. doi: 10.1002/hep.1840020516. DOI: - DOI - PMC - PubMed
    1. Shukla A, Vadeyar H, Rela M, et al. Liver transplantation: east versus west. J Clin Exp Hepatol. 2013;3(3):243–253. doi: 10.1016/j.jceh.2013.08.004. DOI: - DOI - PMC - PubMed
    1. Rana A, Ackah RL, Webb GJ, et al. No gains in long-term survival after liver transplantation over the past three decades. Ann Surg. 2018;269(1):20–27. doi: 10.1097/SLA.0000000000002650. DOI: - DOI - PubMed
    1. Åberg F, Gissler M, Karlsen TH, et al. Differences in long-term survival among liver transplant recipients and the general population: a population-based nordic study. Hepatology. 2015;61(2):668–677. doi: 10.1002/hep.27538. DOI: - DOI - PubMed
    1. Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931–940. doi: 10.1056/NEJMoa021744. DOI: - DOI - PubMed

LinkOut - more resources