Immunosuppression and prevention of rejection

Cyclosporine A (cyclosporin A) has been fundamental to the success of liver transplantation, as with other solid organs. It inhibits T-cell-mediated production of interleukin 2 (IL-2). T suppressor cells are spared, enhancing natural immunosuppression. Triple therapy (cyclosporine A, azathioprine, prednisolone) is usually started within 12 h postoperatively. Some centers start cyclosporine A preoperatively. Daily cyclosporine A levels are required in the early postoperative period, to avoid both subtherapeutic levels and toxicity such as renal failure, neurological complications, and hepatatoxicity mimicking allograft rejection. However, early rejection remains the most common cause of hepatic dysfunction after orthotopic liver transplantation, with at least one rejection episode occurring in two-thirds of recipients. The dose of cyclosporine A should be reduced or its introduction delayed in patients with evolving renal dysfunction.

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