Abstract
To prevent rejection, liver transplant providers largely base their management decisions
on their clinical impression and pharmacokinetics. Clinical impression relies on assessing
graft function, liver enzymes, and biopsy. High immunosuppressive drug levels, although
minimizing rejection, are related to significant side effects such as nephrotoxicity
and metabolic syndrome, contributing to long-term morbidity and mortality. Similarly,
levels that are lower than necessary can decrease the rate of side effects with a
potential toll on rejection and graft survival. Herein, the authors present an update
on immunosuppressive drug level monitoring and manipulation strategies according to
different scenarios and time from transplant. They also provide a brief overview of
next level immunosuppression monitoring strategies that aim to properly balance rejection
rates with drug side effect profiles.
Keywords
immunosuppression - liver transplant - drug level monitoring - immune monitoring
