title: Immunosuppression strategies after liver transplantation: a single centre experience in 57 liver transplant recipients.
abstract: BACKGROUND
  The art of administering immunosuppression lies in the ability to achieve a delicate balance between rejection and infection, thus maximizing patient survival and minimizing morbidity.
  
  
  OBJECTIVE
  To analyze the effect of immunosuppression strategies following liver transplant on the incidence of acute rejection, bile leak, renal dysfunction and posttransplant graft unrelated infection.
  
  
  METHODS
  A retrospective analysis of immunosuppression regimens in 57 liver transplant recipients between Jan 1998 to July 2004 at a single institution.
  
  
  METHODS
  For the purpose of study, the patients were divided into two groups: A - Cyclosporine based therapy (n=37), and B - Tacrolimus based therapy (n=20). In addition, both groups received Azathioprine or Mycophenolate mofetil with steroids. There were two subgroups in each Group A and B: Group C - Received induction using IL2Rab (n=5), and D - Where Sirolimus was used instead of Mycophenolate mofetil (N=7). The subgroups were equally distributed among the basic groups. The regimen was started based on one of the standard protocols but changes were made according to the clinical status of each patient.
  
  
  METHODS
  The statistical analysis was done using Chi square test on SPSS12.
  
  
  RESULTS
  A lower incidence of rejection was observed in Tacrolimus group compared to Cyclosporine group. There was an unacceptably high incidence of bile leak in patients where Sirolimus was used as an adjunct. IL2Rab enabled us to maintain a lower trough level of Tacrolimus for maintenance and enabled us to discontinue steroids earlier.
  
  
  CONCLUSIONS
  Based on this study we dropped Sirolimus from our immunosuppression protocol and the encouraging results obtained with tacrolimus based therapy have supported its use as standard therapy in our immunosuppression regimens.
authors.affiliation: Dept. of Hepatobiliary Surgery and Multiorgan Transplant, Indraprastha Apollo Hospitals, Mathura Road, New Delhi, India.
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sharma
authors.forename: M R
authors.initials: MR
authors.lastname: Rajasekar
authors.forename: Arun
authors.initials: A
authors.lastname: Raghuvanshi
keywords: Immunosuppression; Rejection; Transplant