title: Is there such a thing as protocol immunosuppression in liver transplantation?
abstract: Protocol immunosuppression in liver transplantation is largely an outdated concept. Immunosuppression is now personalized to the individual patient on the basis of several factors including underlying etiology of original liver disease (e.g., HCV, hepatocellular carcinoma), renal function, metabolic co-morbidities and the patient's immunological state. These include omission of corticosteroids in HCV infection and those with major metabolic risk factors, the minimization of calcineurin inhibitors in the presence of renal dysfunction and the use of mTOR inhibitors in patients with malignancy. The basis for such decision-making is discussed in this editorial.
authors.affiliation: Royal Prince Alfred Hospital - A W Morrow Gastroenterology and Liver Centre, Sydney, New South Wales, Australia.
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: McCaughan
authors.forename: Kenny Ching Pan
authors.initials: KC
authors.lastname: Sze
authors.forename: Simone I
authors.initials: SI
authors.lastname: Strasser
mesh_terms: D002985:Clinical Protocols; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000493:pharmacokinetics; D016031:Liver Transplantation / Q000009:adverse effects; D018579:Patient Selection; D057285:Precision Medicine; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: hepatitis C; immunosuppression; liver transplantation; rejection; renal failure