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Current strategies for immunosuppression following liver transplantation

  • Review Article
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Abstract

Background

New strategies for immunosuppression (IS) after liver transplantation (LTx) are in part responsible for the increased patient and graft survival seen over time. With a few basic exceptions—notably the continued use of steroids and calcineurin inhibitors (CNIs)—IS drugs and regimens being used today are different from those used 30 years ago. While graft loss due to acute or chronic rejection has become rare, the side effect burden of IS drugs exerts a significant toll on patients.

Concepts/trends

CNIs continue to form the backbone of IS regimens, although their use is hampered by nephrotoxicity and other adverse effects. Consequently, a variety of CNI reduction or withdrawal strategies have formed the basis of clinical trials or entered into clinical practice. These trials have included the use of everolimus, an mTOR inhibitor, and anti-interleukin-2 receptor antibodies. Basiliximab, as well as other lymphocyte nondepleting and depleting agents, have shown benefit in induction regimens.

Summary

Along with steroid reduction or elimination, current strategies for IS after LTx continue to explore novel combinations of agents, with an aim toward striking a balance between diminution of rejection and the need for avoiding adverse effects of the IS drugs. Long-term maintenance strategies are also discussed in this review, as is development of tolerance and antibody-mediated rejection.

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Acknowledgments

Medical writing assistance was provided by Steven Tresker of Cactus Communications.

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The data and analyses reported in the 2011 Annual Data Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients have been supplied by UNOS and the Minneapolis Medical Research Foundation under contract with HHS/HRSA. The authors alone are responsible for reporting and interpreting these data; the views expressed herein are those of the authors and not necessarily those of the US Government.

The figures appearing in this review were redrawn from figures appearing in the 2011 Annual Report for the liver. According to the Scientific Registry of Transplant Recipients, copyright permissions are not needed.

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  1. Department of Internal Medicine IV, University Hospital of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany

    Daniel Nils Gotthardt & Karl Heinz Weiss

  2. Department of Surgery, University Hospital of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Helge Bruns & Peter Schemmer

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Gotthardt, D.N., Bruns, H., Weiss, K.H. et al. Current strategies for immunosuppression following liver transplantation. Langenbecks Arch Surg 399, 981–988 (2014). https://doi.org/10.1007/s00423-014-1191-9

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