What immunosuppressive therapy regimens are commonly used in liver transplant patients, and what are their side effects?

Common immunosuppressive therapy regimens in liver transplant patients typically include a combination of calcineurin inhibitors (such as tacrolimus or cyclosporine), corticosteroids, and antiproliferative agents like mycophenolate mofetil. These regimens aim to prevent graft rejection while balancing the risk of adverse effects ¹.

Calcineurin inhibitors are the cornerstone of immunosuppression but are associated with nephrotoxicity, neurotoxicity, hypertension, and an increased risk of infections and malignancies. Corticosteroids contribute to side effects such as diabetes, osteoporosis, hypertension, and increased susceptibility to infections. Mycophenolate mofetil can cause gastrointestinal disturbances and bone marrow suppression ¹.

Recent literature emphasizes the importance of tailoring immunosuppression to reduce long-term complications, including the risk of solid non-skin tumors, which are notably increased post-liver transplant due to immunosuppression. Lifestyle factors and careful management of immunosuppressive regimens are critical in mitigating these risks (Carenco et al., 2016).

Strategies such as minimising corticosteroid use and adjusting calcineurin inhibitor doses are often employed to reduce toxicity while maintaining graft function. Additionally, mTOR inhibitors may be considered in some cases to reduce the risk of malignancy, although their use must be balanced against potential side effects like dyslipidaemia and impaired wound healing (Carenco et al., 2016) ¹.