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International Liver Transplantation Society Consensus Statement on Immunosuppression in Liver Transplant Recipients

Charlton, Michael, MD1; Levitsky, Josh, MD2; Aqel, Bashar, MD3; O'Grady, John, MD4; Hemibach, Julie, MD5; Rinella, Mary, MD2; Fung, John, MD1; Ghabril, Marwan, MD6; Thomason, Ray, MD7; Burra, Patrizia, MD8; Little, Ester, Coelho, MD9; Berenguer, Marina, MD10; Shaked, Abraham, MD11; Trotter, James, MD12; Roberts, John, MD13; Rodriguez-Davalos, Manuel, MD14; Rela, Mohamed, MBBS4; Pomfret, Elizabeth, MD15; Heyrend, Caroline, PharmD14; Gallegos-Orozco, Juan, MD7; Saliba, Faouzi, MD16

doi: 10.1097/TP.0000000000002147
Reviews

Effective immunosupression management is central to achieving optimal outcomes in liver transplant recipients. Current immunosuppression regimens and agents are highly effective in minimizing graft loss due to acute and chronic rejection but can also produce a substantial array of toxicities. The utilization of immunosuppression varies widely, contributing to the wide disparities in posttransplant outcomes reported between transplant centers. The International Liver Transplantation Society (ILTS) convened a consensus conference, comprised of a global panel of expert hepatologists, transplant surgeons, nephrologists, and pharmacologists to review the literature and experience pertaining to immunosuppression management to develop guidelines on key aspects of immunosuppression. The consensus findings and recommendations of the ILTS Consensus guidelines on immunosuppression in liver transplant recipients are presented in this article.

The ILTS consensus document on immunosuppression in liver transplant recipients covers both the scope of therapeutic agents for induction and rejection therapy as well as an overview of complications and clinical management.

1 Transplant Institute, University of Chicago, Chicago, IL.

2 Kovler Transplant Institute, Northwestern Memorial Hospital, Chicago, IL.

3 Transplant Center, Mayo Clinic Arizona, Phoenix, AZ.

4 Liver Transplant Unit, King’s College Hospital, London, England, UK.

5 Transplant Center, Mayo Clinic, Rochester, MN.

6 Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, IN.

7 Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, UT.

8 Multivisceral Transplant Unit, Padova University, Padova, Italy.

9 Banner University Medical Center, Phoenix, AZ.

10 Liver Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain.

11 Transplant Institute, Pennsylvania University Hospital, Philadelphia, PN.

12 Simmons Transplant Institute, Baylor University Medical Center, Dallas, TX.

13 Department of Surgery, University of California San Francisco, San Francisco, CA.

14 Intermountain Transplant Center, Primary Children’s Hospital, Salt Lake City, UT.

15 Transplant Center, University of Colorado Medical Center, Denver, CO.

16 Center Hépato-Biliaire, Hospital Paul-Brousse, Paris, France.

Received 21 December 2017. Revision received 23 January 2018.

Accepted 5 February 2018.

M.C. received research support and is a consultant for Gilead, Merck, Janssen, Bristol Myers, Novartis, and AbbVie. M.B. received grants from Gilead and is a member of the advisory boards for Gilead, Abbvie, MSD, BMS, partially funded by the Instituto de Salud Carlos III (ISCIII). P.B. is in the advisory board, speaker of Astellas, Gilead, Kedrion, Biotest, and Sandoz, travel in the last 2 years supported by Astellas, Gilead, Kedrion, Biotest, and Sandoz. M.R. is a consultant for Gilead, Enanta, Intercept, Genfit, Chronic Liver Disease Foundation, and Novartis. J.F. received research support and is a consultant for Novartis and Atellas. J.G.-O. is in the advisory board for Abbvie and Gileadand received clinical trial support from Allergen, Conatus, Genfit, Gilead, Intercept, and Mallinckrodt. M.G. and R.T. declare no conflicts of interest. F.S. received research support and si a consultant for Novartis and Atellas.

M.C. participated in the conception, study design, acquisition and interpretation of results, drafting and revision of the article. J.L. participated in the conception, study design, acquisition and interpretation of results, drafting and revision of the article, joint first author. B.A. participated in the study design, acquisition and interpretation of results, editing of the article. J.O’G. participated in the study design, acquisition and interpretation of results, editing of the article. J.H. participated in the study design, acquisition and interpretation of results, editing of the article. M.R. participated in the study design, acquisition and interpretation of results, editing of the article. M.G. participated in the study design, acquisition and interpretation of results, editing of the article. R.T. participated in the study design, acquisition and interpretation of results, editing of the article. P.B. participated in the study design, acquisition and interpretation of results, editing of the article. E.C.L. participated in the study design, acquisition and interpretation of results, editing of the article. M.B. participated in the study design, acquisition and interpretation of results, editing of the article. A.S. participated in the study design, acquisition and interpretation of results, editing of the article. J.T. participated in the study design, acquisition and interpretation of results, editing of the article. J.R. participated in the study design, acquisition and interpretation of results, editing of the article. M.R-D. participated in the study design, acquisition and interpretation of results, editing of the article. M.R. participated in the study design, acquisition and interpretation of results, editing of manuscript. E.P. participated in the study design, acquisition and interpretation of results, editing of the article.

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