Immunosuppressive management

Like most other allografts, a liver transplant will be rejected by the recipient unless immunosuppressive drugs are used. The immunosuppressive regimens for all solid organ transplants are fairly similar, and a variety of agents are now available.

Most transplant centers use either two of three agents. This typically involves a combination of a calcineurin inhibitor (CNI) such as cyclosporine (Neoral) or tacrolimus (Prograf), a glucocorticoid such as prednisone (Medrol, Prelone, Sterapred DS), and a third agent such as azathioprine (Imuran), mycophenolate mofetil (CellCept), or sirolimus(Rapamune). Once patients achieve adequate liver function and are free from rejection for six months, ongoing immunosuppression can often be with monotherapy, typically a CNI. You must take these drugs exactly as prescribed for the rest of your life.

Liver transplantation is unique in that the risk of chronic rejection also decreases over time, although the great majority of recipients need to take immunosuppressive medication for the rest of their lives. It is possible to be slowly taken off anti rejection medication but only in certain cases. It is theorized that the liver may play a yet-unknown role in the maturation of certain cells pertaining to the immune system. There is at least one study by Thomas E. Starzl’s team at the University of Pittsburgh which consisted of bone marrow biopsies taken from such patients which demonstrate genotypic chimerism in the bone marrow of liver transplant recipients.