title: Selection and use of immunosuppressive therapies after liver transplantation: current German practice.
abstract: In recent years, immunosuppression (IS) after liver transplantation (LT) has become increasingly diversified as the choice of agents has expanded and clinicians seek to optimize the balance of immunosuppressive potency with the risk of adverse events in individual patients. Calcineurin inhibitors (CNIs) are the primary agents used for patients undergoing liver transplantation. Other therapeutic agents like interleukin-2 receptor antagonists are not universally administered, but can be considered for the delay or reduction in CNI exposure. An early addition of mycophenolate mofetil (MMF) or the mTOR inhibitor everolimus also allows for the reduction in the CNI dose. To reduce the risk of malignancy, in particular of skin tumors, as well as to prevent the deterioration of renal function, everolimus-based therapy may be advantageous. Apart from patients with autoimmune hepatitis, steroids are withdrawn within 3-6 months after transplantation. Overall, immunosuppression can only be standardized in a limited proportion of patients due to specific clinical requirements and risk factors. Future studies should attempt to refine accurate individualization of the immunosuppressive regimen in specific difficult-to-treat patient subpopulations.
authors: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, University Duisburg-Essen, Essen, Germany.|Department of Gastroenterology and Hepatology, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
authors: Kerstin
authors: K
authors: Herzer
authors: Department for Gastroenterology and Hepatology, University Hospital Bonn, Bonn, Germany.
authors: Christian P
authors: CP
authors: Strassburg
authors: Department for Transplantation Surgery, University Hospital Kiel, Kiel, Germany.
authors: Felix
authors: F
authors: Braun
authors: Department for Gastroenterology and Rheumatology, Section Hepatology, University of Leipzig, Leipzig, Germany.
authors: Cornelius
authors: C
authors: Engelmann
authors: Department for Transplant Surgery, University Hospital Munich, Munich, Germany.
authors: Markus
authors: M
authors: Guba
authors: Department for Transplant Surgery, University Hospital Hannover, Hannover, Germany.
authors: Frank
authors: F
authors: Lehner
authors: Department for General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany.
authors: Silvio
authors: S
authors: Nadalin
authors: Department of Visceral and Transplant Surgery, Charite-Universitätsmedizin Berlin, Berlin, Germany.
authors: Andreas
authors: A
authors: Pascher
authors: Department for General-, Visceral- and Transplant Surgery, University Hospital Regensburg, Regensburg, Germany.
authors: Marcus N
authors: MN
authors: Scherer
authors: Clinic for General and Visceral Surgery, Frankfurt University Hospitals, Goethe University Frankfurt/Main, Frankfurt/Main, Germany.
authors: Andreas A
authors: AA
authors: Schnitzbauer
authors: Department for Gastroenterology and Hepatology, University Hospital Mainz, Mainz, Germany.
authors: Tim
authors: T
authors: Zimmermann
authors: Department for Hepatobiliary Surgery and Transplantation, University Hospital Hamburg, Hamburg, Germany.
authors: Björn
authors: B
authors: Nashan
authors: University Transplant Center, University Hospital Hamburg, Hamburg, Germany.
authors: Martina
authors: M
authors: Sterneck
mesh_terms: D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000009:adverse effects*; D010818:Practice Patterns, Physicians'
chemical_list: D007166:Immunosuppressive Agents
keywords: antiproliferative drugs; calcineurin inhibitors; everolimus; immunosuppression; induction; liver transplantation; mycophenolate mofetil; steroids