Immunology of liver transplantation: Clinical management aspects

Orthotopic liver transplantation has developed into the treatment of choice for many patients who develop complications of end-stage liver disease. With improvements in surgical technique and overall survival since the inception of liver grafting, a major consideration in the long-term care of liver transplant patients has become the management of allograft rejection and immunosuppressive therapy. With an increasing number of patients having undergone successful transplantation in the community, practicing gastroenterologists will likely be called upon more frequently to render care to these patients. In this article, the immunobiology of transplantation and rejection is discussed with an emphasis placed on the T-cell - major histocompatibility complex interaction, cytokine stimulation, and adhesion molecule binding. Commonly used immunosuppressive medications and promising ones for the future are reviewed. Also, clinical aspects of the short- and long-term management of immunosuppression are explored.