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Evolving concepts in the selection of immunosuppression regimen for liver transplant recipients

Authors Locke JE, Singer A

Published 13 May 2011 Volume 2011:3 Pages 53—62


Review by Single anonymous peer review

Peer reviewer comments 2

Jayme E Locke, Andrew L Singer
Johns Hopkins Medical Institutions, Department of Surgery, Division of Transplantation, Baltimore, MD, USA

Abstract: The introduction of calcineurin inhibitor (CNI) based immunosuppression has revolutionized the field of liver transplantation by dramatically reducing the incidence of acute cellular rejection and prolonging patient and allograft survival. However, the introduction of CNIs has also come at the price of increased patient morbidity, particularly with regard to the well-known nephrotoxic effects of the medications. In an effort to minimize the adverse effects, immunosuppression regimen have evolved to include the use of various induction agents and purine synthesis inhibitors to limit the dose of CNI necessary to achieve low acute cellular rejection rates. Careful assessments of risks and benefits are needed as these newer agents have their own side effect profiles. In addition, the impact of newer immunosuppression regimen on hepatitis C (HCV) recurrence has not been completely elucidated. This review will provide an overview of the most common immunosuppression regimen used in liver transplantation and discuss their impact on acute cellular rejection, patient and allograft survival, and HCV recurrence.

Keywords: liver transplantation, immunosuppression, acute cellular rejection, patient and graft survival, hepatitis C recurrence

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