Immunosuppression Strategies After a Liver Transplant

A liver transplant is most frequently used for livers damaged by nonalcoholic and alcoholic cirrhosis (scarring). Rejection of a new liver by the body's immune system is a common complication of transplantation. Immunosuppression is a technique used to combat rejection and allow the transplanted liver an opportunity to work properly.

Treatment Strategies

• If you undergo a liver transplant, it is highly possible that your body's immune system will identify your new liver as a foreign object, and attack it in the same way it would attack a virus or other harmful invader. This rejection reaction is the most serious potential consequence of transplantation, and may lead to progressive performance decreases in your liver, as well as eventual liver failure. To fight the possibility of rejection, your doctor will prescribe a combination of medications from a class of drugs called immunosuppressants, which decrease your body's natural immune response. According to the National Digestive Diseases Information Clearinghouse, common examples of immunosuppressants include cyclosporine (Neoral, Sandimmune), tacrolimus (Prograf), steroids (prednisolone, prednisone), mycophenolate mofetil (CellCept) and sirolimus (Rapamune).
  Your immunosuppressant treatment will begin during or immediately after your transplant surgery. According to the American Society of Transplantation, you will typically receive a high oral or intravenous dose of steroids, which may be followed after surgery by additional high-level doses if signs of rejection appear. You will likely receive lower doses of steroids as part of your immunosuppression strategy for six to 12 months after your transplant.
  Your doctor will prescribe additional immunosuppressants based on a number of circumstances, including your susceptibility to medication side effects. Since these compounds work directly on your immune system, proper treatment requires a delicate balance between fighting rejection and risking the dangers of serious infection. Your doctor will not know in advance how you will respond to a given combination of medications, and he may need to experiment considerably to maintain an adequate level of care.
  The most important thing you can do to support your doctor's chosen immunosuppression strategy is to take your medication strictly according to instructions. When you see your doctor for follow-up examinations, he may also ask you to demonstrate how and when you use your medications so he can make sure that no errors or oversights occur. Under no circumstances should you stop taking any of your immunosuppressants or adjust your medication dosage without talking to your doctor first.

Complications

• In addition to increased risk of infection, immunosuppressant use can lead to blood pressure and cholesterol increases, diabetes, kidney damage, bone weakness and weight gain. Your doctor will test you for these complications, and adjust your medications as much as possible to diminish their effects. Once you begin immunosuppressant treatment, you will need to follow it for life or risk losing your new liver. By working with your doctor, you can help create an immunosuppression strategy that is both adaptable and able to support your health for years to come.