43. Immunosuppression: The Global Picture

  1. Eugene R. Schiff MD, MACP, FRCP2,
  2. Willis C. Maddrey MD, MACP, FRCP3 and
  3. Michael F. Sorrell MD, FACP4
  1. Russell H. Wiesner MD

Published Online: 31 OCT 2011

DOI: 10.1002/9781119950509.ch43

Schiff's Diseases of the Liver, Eleventh Edition

Schiff's Diseases of the Liver, Eleventh Edition

How to Cite

Wiesner, R. H. (2011) Immunosuppression: The Global Picture, in Schiff's Diseases of the Liver, Eleventh Edition (eds E. R. Schiff, W. C. Maddrey and M. F. Sorrell), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781119950509.ch43

Editor Information

  1. 2

    Center for Liver Diseases and Schiff Liver Institute, University of Miami Miller School of Medicine, Miami, FL, USA

  2. 3

    Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA

  3. 4

    University of Nebraska College of Medicine, Omaha, NE, USA

Author Information

  1. Transplant Center, Mayo Clinic Rochester, MN, USA

Publication History

  1. Published Online: 31 OCT 2011
  2. Published Print: 9 DEC 2011

ISBN Information

Print ISBN: 9780470654682

Online ISBN: 9781119950509



  • Immunosuppressive drugs;
  • calcineurin inhibitors;
  • antimetabolites;
  • mTOR inhibitors;
  • three signal pathway;
  • tolerance;
  • lymphocyte-depleting antibodies;
  • nonlymphocyte-depleting antibodies;
  • rejection cholangitis;
  • endotheliitis;
  • alloreactivity


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.