Table 1.
Commonly used immunosuppressive agents in liver transplantation and their target pathways.
| Immunosuppressive agent | Target pathway | ||||
|---|---|---|---|---|---|
| Pharmacological | |||||
|
| |||||
| Corticosteroids | (a) Inhibits cytokine transcription by antigen presenting cell | ||||
| (b) Selective lysis of immature cortical thymocytes | |||||
| Calcineurin inhibitors (cyclosporine/neoral and tacrolimus/Prograf/Fk506) | Inhibits Signal 2 transduction via T cell receptor | ||||
| Mammalian Target of rapamycin inhibitors (sirolimus/rapamycin, everolimus) | Inhibits signal 3 transduction via IL-2 receptor | ||||
| Azathioprine (Imuran) | Inhibits purine and DNA synthesis | ||||
| Mycophenolic acid (cell cept) | Inhibits purine and DNA synthesis | ||||
|
| |||||
| Biological | |||||
|
| |||||
| Anti-CD3 monoclonal antibodies (OKT3) | (a) Causes depletion and receptor modulation in T cell | ||||
| (b) Interferes with signal 1 | |||||
| Antithymocyte globulin (ATG) | (a) Causes depletion and receptor modulation in T cells | ||||
| (b) Interferes with signal 1, 2 and 3 | |||||
| (c) Inhibits lymphocyte trafficking | |||||
| Anti IL-2 alpha chain receptor antibodies (Basiliximab, Daclizumumab) | Inhibits T cell proliferation to IL-2 (signal 3) | ||||
| Anti-CD52 monoclonal antibodies (campath 1-H) | Causes depletion of thymocytes, T cells, B cells (not plasma cells) and monocytes | ||||