Rejection and Immunosuppression Trends in Liver Transplantation

Immunosuppressive therapy has progressively advanced since the inception of liver transplantation. The calcineurin-inhibitor (CNI) tacrolimus (TAC) remains the backbone of the immunosuppressive regimen. However, new agents with better side-effect profiles have taken a more prominent role in the immunosuppressive regimen of current liver transplant recipients to minimize complications in these vulnerable patients. Despite the development of highly effective immunosuppressive agents over the past several decades, acute cellular rejection (ACR) remains an important problem after liver transplantation. Although less common, chronic rejection is frequently progressive and often leads to graft failure requiring consideration for re-transplantation. The goal of this chapter is to discuss the different types of rejection that may occur and their treatment as well as to review the current immunosuppressive protocols for liver transplantation.