Immunosuppression: The Global Picture

The central issue in liver transplantation remains suppression of allograft rejection. Thus, the development of immunosuppressive drugs has been the key to successful allograft function. Immunosuppressive agents are used for induction during the initial days after transplant, during maintenance, and for reversal of established rejection. This chapter centers on the evolution of immunosuppressive therapy over the past three decades. It discusses how the strategy and goals of immunosuppression have changed over the years. Finally, the ultimate goal of tolerance is touched on and the future is considered for the possible individualization of immunosuppressive drugs to reduce not only the rates of rejection but, more importantly, to minimize toxicity.