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Immunosuppression after Liver Transplantation

Liver Unit Queen Elizabeth Hospital, J.M.Neuberger{at}bham.ac.uk

The purpose of immunosuppression is to prevent the recipient's immune system from destroying or damaging the graft. Immunosuppression aims to balance under-immunosuppression leading to graft rejection and over-immunosuppression leading to sepsis and malignancy. There have been comparatively few studies on which to base a rational approach to immunosuppression. The types of immunosuppressants are 1) purine analogues such as 6-mercaptopurine (6-MP), 2) inhibitors of inosine monophosphate dehydrogenase such as myciphenolate mofetil (MMF), 3) glucocorticoids such as prednisone, 4) calcineurin binding drugs such as cyclosporin and tacrolimus, 5) TOR inhibitors such as sirolimus, and 6) mono- and polyclonal antibodies. There are five phases in the management of immunosuppression: 1) induction, 2) maintenance, 3) treatment of acute rejection, 4) treatment of chronic rejection, and 5) withdrawal of immunosuppression. Immunosuppression is complicated by intercurrent infection, usually viral or tubucular, and by pregnancy, breast feeding, diabetes mellitus, and renal impairment.

Key Words: liver transplantation • calicineurin inhibitors • anti-CD3

References

• 1. Micromedex Information System. http://www.micromedex.com; info@mdx.com
• 2. Devlin J, Doherty D, Thomson L, Wong T, Donaldson P, Portmann B, et al. Defining the outcome of immunosuppression withdrawal after liver transplantation. Hepatology 1998;27:926-933.[Medline] [Order article via Infotrieve]
• 3. Jain A, Kashyap R, Marsh W, Rohal S, Khanna A, Fung JJ. Reasons for long-term use of steroid in primary adult liver transplantation under tacrolimus. Transplantation 2001;71(8):1102-1106.[Medline] [Order article via Infotrieve]

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This Article Abstract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Saved Citations Download to citation manager Reprints and Permissions Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Neuberger, J. Search for Related Content Social Bookmarking                   What's this?