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Asian Liver Transplant Network Clinical Guidelines on Immunosuppression in Liver Transplantation

Tan, Poh Seng, MBBS, MRCP, FAMS1,2; Muthiah, Mark D., MRCP, MMed1,2; Koh, Tsingyi, PharmD, BCPS3; Teoh, Yee Leong, MMed, FAMS4; Chan, Albert, MBBS, FRCS, FCSHK, FHKAM5; Kow, Alfred, MMed, MRCS, FRCSEd2,6; Zheng, Qishi, MBBS, MPhil4; Kwon, Choon Hyuck David, MD, PhD7; Lee, Guan Huei, MRCP, FRCP, PhD1,2; Lesmana, Cosmas Rinaldi A., Sp.PD, KGEH, FACP, FACG, FINASIM8,9; de Villa, Vanessa, MD, PhD, FPCS, FPSTS10; Fung, James, MD, FRACP, FHKCP, FHKAM11; Lim, Kieron, MBBS, FRCP, FAMS, FRCPEd1,2

doi: 10.1097/TP.0000000000002532

Most management guidelines and much of the available clinical trial evidence for immunosuppressants in liver transplantation (LT) pertain to Western practice. While evidence from Western studies may not translate to Asian settings, there is a paucity of Asian randomized controlled trials of immunosuppression in liver recipients. Nonetheless, there are notable differences in the indications and procedures for LT between Western and Asian settings. The Asian Liver Transplant Network held its inaugural meeting in Singapore in November 2016 and aimed to provide an Asian perspective on aspects of immunosuppression following LT. Because of their importance to outcome following LT, the meeting focused on (1) reducing the impact of renal toxicity, (2) hepatocellular carcinoma recurrence, and (3) nonadherence with immunosuppressant therapy.

1Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, Singapore.

2National University Centre for Organ Transplantation, National University Hospital, National University Health System, Singapore.

3Department of Pharmacy, National University Hospital, National University Health System, Singapore.

4Singapore Clinical Research Institute, Singapore.

5Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, Queen Mary Hospital, Hong Kong.

6Division of Hepatopancreatobiliary Surgery and Division of Liver Transplantation, Department of Surgery, University Surgical Cluster, National University Health System, National University of Singapore, Singapore.

7Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.

8Hepatobiliary Division, Department of Internal Medicine, Cipto Mangunkusumo Hospital, Universitas Indonesia, Jakarta, Indonesia.

9Digestive Disease & GI Oncology Center, Medistra Hospital, Jakarta, Indonesia.

10Department of Surgery and Center for Liver Disease Management and Transplantation, The Medical City, Pasig City, Philippines.

11Department of Medicine, Queen Mary Hospital, Hong Kong.

Received 6 May 2018. Revision received 28 September 2018.

Accepted 29 October 2018.

The consensus meeting was supported by the educational grant provided by Novartis and Astellas.

P.S.T. is a PI of a Novartis sponsored clinical trial (H2307). The other authors declare no conflicts of interest.

P.S.T., M.D.M., and T.K. are co-first authors with equal contribution to writing the draft of the article. J.F. and K.L. are co-senior authors with equal contribution leading the project. All authors reviewed the draft, provided expertise for critical revisions, and approved the final version of the article.

Correspondence: Poh Seng Tan, MBBS, MRCP, FAMS, Division of Gastroenterology and Hepatology, National University Hospital, National University Health System, 1E Kent Ridge Rd Tower Block, Level 10, Singapore 119228. (

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