Side Effects of Immunosuppressant Drugs After Liver Transplant

Liver transplantation (LT) is the standard of care for both end-stage liver failure and hepatocellular carcinoma (HCC). Side effects of the main used immunosuppressive drugs have a noteworthy impact on the long-term outcome of LT recipients. Consequently, to achieve a balance between optimal immunos...

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Main Authors: Filippo Gabrielli, Elisa Bernasconi, Arianna Toscano, Alessandra Avossa, Alessia Cavicchioli, Pietro Andreone, Stefano Gitto
Format: Article
Language:English
Published: MDPI AG 2025-02-01
Series:Pharmaceuticals
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Online Access:https://www.mdpi.com/1424-8247/18/3/342
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author Filippo Gabrielli
Elisa Bernasconi
Arianna Toscano
Alessandra Avossa
Alessia Cavicchioli
Pietro Andreone
Stefano Gitto
author_facet Filippo Gabrielli
Elisa Bernasconi
Arianna Toscano
Alessandra Avossa
Alessia Cavicchioli
Pietro Andreone
Stefano Gitto
author_sort Filippo Gabrielli
collection DOAJ
description Liver transplantation (LT) is the standard of care for both end-stage liver failure and hepatocellular carcinoma (HCC). Side effects of the main used immunosuppressive drugs have a noteworthy impact on the long-term outcome of LT recipients. Consequently, to achieve a balance between optimal immunosuppression and minimal side effects is a cornerstone of the post-LT period. Today, there are no validated markers for overimmunosuppression and underimmunosuppression, only a few drugs have therapeutic drug monitoring, and immunosuppression regimens vary from center to center and from country to country. Currently, there are many drugs with different efficacy and safety profiles. Using different agents permits a decrease in the dosage and minimizes the toxicities. A small subset of recipients achieves immunotolerance with the chance to stop immunosuppressive therapy. This article focuses on the side effects of immunosuppressive drugs, which significantly impact long-term outcomes for LT recipients. The primary aim is to highlight the balance between achieving effective immunosuppression and minimizing adverse effects, emphasizing the role of personalized therapeutic strategies. Moreover, this review evaluates the mechanisms of action and specific complications associated with immunosuppressive agents. Finally, special attention is given to strategies for reducing immunosuppressive burdens, improving patient quality of life, and identifying immunotolerant individuals.
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spelling doaj-art-5df014a1104a43759de32d4aa94ba5bd2025-08-20T03:43:37ZengMDPI AGPharmaceuticals1424-82472025-02-0118334210.3390/ph18030342Side Effects of Immunosuppressant Drugs After Liver TransplantFilippo Gabrielli0Elisa Bernasconi1Arianna Toscano2Alessandra Avossa3Alessia Cavicchioli4Pietro Andreone5Stefano Gitto6Internal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, ItalyPostgraduate School of Internal Medicine, University of Modena and Reggio Emilia, 41126 Modena, ItalyDivision of Internal Medicine, University Hospital of Policlinico G. Martino, 98124 Messina, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, 50134 Florence, ItalyInternal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, ItalyInternal and Metabolic Medicine, Department of Medical and Surgical Sciences for Children & Adults, AOU of Modena, University of Modena and Reggio Emilia, 41126 Modena, ItalyDepartment of Experimental and Clinical Medicine, University of Florence, 50134 Florence, ItalyLiver transplantation (LT) is the standard of care for both end-stage liver failure and hepatocellular carcinoma (HCC). Side effects of the main used immunosuppressive drugs have a noteworthy impact on the long-term outcome of LT recipients. Consequently, to achieve a balance between optimal immunosuppression and minimal side effects is a cornerstone of the post-LT period. Today, there are no validated markers for overimmunosuppression and underimmunosuppression, only a few drugs have therapeutic drug monitoring, and immunosuppression regimens vary from center to center and from country to country. Currently, there are many drugs with different efficacy and safety profiles. Using different agents permits a decrease in the dosage and minimizes the toxicities. A small subset of recipients achieves immunotolerance with the chance to stop immunosuppressive therapy. This article focuses on the side effects of immunosuppressive drugs, which significantly impact long-term outcomes for LT recipients. The primary aim is to highlight the balance between achieving effective immunosuppression and minimizing adverse effects, emphasizing the role of personalized therapeutic strategies. Moreover, this review evaluates the mechanisms of action and specific complications associated with immunosuppressive agents. Finally, special attention is given to strategies for reducing immunosuppressive burdens, improving patient quality of life, and identifying immunotolerant individuals.https://www.mdpi.com/1424-8247/18/3/342orthotopic liver transplantimmunosuppressionside effectcardiovascular diseasenephrotoxicitymetabolic syndrome
spellingShingle Filippo Gabrielli
Elisa Bernasconi
Arianna Toscano
Alessandra Avossa
Alessia Cavicchioli
Pietro Andreone
Stefano Gitto
Side Effects of Immunosuppressant Drugs After Liver Transplant
Pharmaceuticals
orthotopic liver transplant
immunosuppression
side effect
cardiovascular disease
nephrotoxicity
metabolic syndrome
title Side Effects of Immunosuppressant Drugs After Liver Transplant
title_full Side Effects of Immunosuppressant Drugs After Liver Transplant
title_fullStr Side Effects of Immunosuppressant Drugs After Liver Transplant
title_full_unstemmed Side Effects of Immunosuppressant Drugs After Liver Transplant
title_short Side Effects of Immunosuppressant Drugs After Liver Transplant
title_sort side effects of immunosuppressant drugs after liver transplant
topic orthotopic liver transplant
immunosuppression
side effect
cardiovascular disease
nephrotoxicity
metabolic syndrome
url https://www.mdpi.com/1424-8247/18/3/342
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