Perioperative and Postoperative Use of Immunosuppressive Agents in Liver Transplantation

摘要

Immunosuppression after liver transplantation is essential for graft and patient survival. At the inception of solid organ transplantation over 50 years ago, drug regimens were limited, the toxicities were high, and the efficacy and specificity of each agent was low Transplant physicians now have more drugs in their armamentarium, but there is no gold standard or optimal protocol for immunosuppression across transplant centers. Each transplant program uses its own regimen, based on its own personal clinical experience and published scientific and clinical data. In addition, each transplant center individualizes the choice of immunosuppressive drugs, either as monotheraphy or combination therapy, and arbitrarily decides the optimal dosages and target trough blood levels. The decision to use induction therapy, the type of induction therapy, and the timing of instituting a therapy after liver transplantation also is often arbitrary. But the goal at each center is the same-to achieve graft acceptance without substantially increasing the risk of infection and malignancy.