Management of immunosuppressant agents following liver transplantation: Less is more

Abstract

Immunosuppression in organ transplantation was revolutionary for its time, but technological and population changes cast new light on its use. First, metabolic syndrome (MS) is increasing as a public health issue, concomitantly increasing as an issue for post-orthotopic liver transplantation patients; yet the medications regularly used for immunosuppression contribute to dysfunctional metabolism. Current mainstay immunosuppression involves the use of calcineurin inhibitors; these are potent, but nonspecifically disrupt intracellular signaling in such a way as to exacerbate the impact of MS on the liver. Second, the impacts of acute cellular rejection and malignancy are reviewed in terms of their severity and possible interactions with immunosuppressive medications. Finally, immunosuppressive agents must be considered in terms of new developments in hepatitis C virus treatment, which undercut what used to be inevitable viral recurrence. Overall, while traditional immunosuppressive agents remain the most used, the specific side-effect profiles of all immunosuppressants must be weighed in light of the individual patient.

Influence of ABCB1 gene polymorphism on concentration to dose ratio and adverse effects of tacrolimus in Pakistani liver transplant recipients

“…Liver transplant (LT) is a curative procedure for end-stage liver disease and is followed by immune suppression therapy in transplant recipients. 1 The use of tacrolimus for post-liver transplant immune suppression was first reported in the year 1989; since then, tacrolimus has become a popular post solid organ transplantation immunosuppressant agent and is also used in the treatment of autoimmune disorders by using oral, sublingual or intravenous route. It acts by blocking calcium-dependent phosphatase enzyme calcineurin, thereby suppressing signal 2 which is required for T cell activation.…”

The molecular diagnosis of rejection in liver transplant biopsies: First results of the INTERLIVER study

“…Moreover, the diagnosis and prevalence of antibody‐mediated rejection (ABMR) in liver transplants remain controversial 5,13‐15 . Liver transplants present unique challenges because of their tolerogenic properties, inviting clinicians to consider reducing immunosuppression 16‐20 . However, this practice requires a precise and accurate system for diagnosing rejection 21‐25 .…”

The Immunomodulatory Properties of Mesenchymal Stem Cells Play a Critical Role in Inducing Immune Tolerance after Liver Transplantation

“…Thus, given the small sample size and short follow-up period, the possibility of infections after MSCs remains to be taken seriously. (5) Validity concerns: a large number of in vivo and in vitro experiments have proven that MSCs were effective in treatments of alloimmune response after liver transplantation [41][42][43]45]. A randomized controlled clinical trial by Shi et al was conducted to evaluate the clinical feasibility of UC-MSC therapy in liver transplant patients with acute graft rejection [46].…”