Immunosuppression and Tolerance in Adult Liver Transplantation. A literature review on the immunosuppression-drugs after a liver transplantation; how to best provide safe treatment and good quality of life.

Abstract

Background: There is increasing interest in long-term management issues in liver transplantation recipients; quality of life, complications related to extended immunosuppressants, natural development of co-morbidities and recurrent disease. IS agents are used in induction of the liver transplantation, maintenance of the organ, and reversal of organ rejection. Aim: A systematic literature search with the purpose of summaries the existing clinical research on this specific topic; immunosuppressive medications post-liver transplantation. Material and methods: Search method in PubMed; Medical Subject Headings, with the terms: ("Liver Transplantation"[Mesh]) AND "Immunosuppression" [Mesh]. The selected studies were assessed for scientific quality and relevance for the thesis. Results: Steroid-based IS are responsible for a substantial post-LTx morbidity and mortality, hence, minimization of its use is of utmost importance to improve patient’s quality of life. Because of systemic steroids impact on all organs in the human body and all its side effects that increases risk factors of morbidity. It is important to comprehend the hepatic disease and the patient, as well as understanding the efficacies and side effects/interactions of IS medication. This way the doctor and the patient can strike a balance between suppression of rejection and minimization of side effects. The patient group are very complex, and this have been shown to be a challenge when it comes to comparing the result on the effect of different studies with different immunosuppression’s as the reason for liver failure have a lot to say for graft rejection and patient survival, especially for complication accruing with lifelong IS. Conclusion: LTx recipients are an inherently complex population, with diverse and serious underlying medical concerns that have the potential to adversely affect posttransplant outcomes, thus would a general IS therapy lead to a greater rejection rate. There is a need for more clinical studies, random control trails, that can help us finding the best immunosuppressive treatment for liver transplanted patients.