Optimizing Immunosuppression in Liver Transplant Recipients

While immunosuppression is effective in preventing rejection following LT, it may be sub-optimal for some recipients or too aggressive in others, leading to complications of under- or over-immunosuppression. Many programs have a "one size fits all" approach, leading to standard protocols for everyone and only changed when complications occur (rejection or infection, etc). The field needs to move toward more personalized approaches incorporating clinical characteristics, disease states, diagnoses at the time of transplantation, etc in order to optimize immunosuppression therapy. This four-part webinar series will discuss the use of different approaches and the data that support their implementation. Click "Browse Sessions" or "Entire Conference" to view the four sections.

Overview of immunosuppression in liver transplant recipients

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Overview of immunosuppression in liver transplant recipients

Identification: 001

After participating in this activity, the learner will be able to:

• Identify the mechanisms of action of the main immunosuppression therapies used in liver transplantation.
• Discuss the use of specific induction and maintenance agents by liver transplant programs over time.
• Explain therapeutic drug monitoring of immunosuppression therapies and the general approach to monitoring immunosuppression in liver transplant recipients.

Speaker(s):

• Josh Levitsky, MD, MS, Northwestern University

Immunosuppression in the setting of viral disease and malignancy

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Immunosuppression in the setting of viral disease and malignancy

Identification: 002

After participating in this activity, the learner will be able to:

• Explain the effects of various immunosuppressive agents on the recurrence of hepatitis C in liver transplant recipients.
• Discuss immunosuppressive options with my patients with hepatitis C virus infection.
• Describe the effects of bolus dose steroids and depleting T cell antibodies on the histological recurrence of HCV after treatment for rejection.

Speaker(s):

• Michael Curry, MD, Beth Israel Deaconess Medical Center Boston, MA

Immunosuppression in patients at higher risk for rejection

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Immunosuppression in patients at higher risk for rejection

Identification: 004

After participating in this activity, the learner will be able to:

• Be clinically aware of the possibility of antibody-mediated rejection in the differential diagnosis of allograft dysfunction post-liver transplantation.
• Identify patients post-liver transplantation that are at increased risk of rejection and describe how best to manage them.

Speaker(s):

• Thomas Schiano, MD, Icahn School of Medicine, Mt. Sinai

Immunosuppression in the setting of renal dysfunction

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Immunosuppression in the setting of renal dysfunction

Identification: 003

After participating in this activity, the learner will be able to:

• Describe at least three potential consequences of chronic renal dysfunction following liver transplantation and the impact on patient outcomes.
• Summarize three common renal sparing immunosuppression strategies in the liver alone recipient with chronic renal dysfunction.
• Explain at least two factors that determine renal outcomes following simultaneous liver-kidney transplant and what effect these may have on choice of immunosuppression protocol.

Speaker(s):

• Lisa VanWagner, MD, MSc, FAST, FAHA, Northwestern Medicine