TABLE 2. Immunosuppression regimen and therapeutics during episodes of late acute rejection.

Studies	Immunosuppression regimen	Therapeutic LAR episode
Ramji, A. et al. 20026	32 patients (33%) were ST tapered within the previous 8 weeks, 15 patients (16%) were not on any ST, 48 (50%) had ST dose of prednisone 5 mg or less daily. 17 patients (18%) had sub therapeutic CsA or TAC levels at least once during the preceding eight weeks: four in TAC (≤5 ng/mL) and 13 in the CsA group (level ≤100 ng/mL)	73% of LAR episodes were treated with pulse intravenous ST. The remaining rejection episodes were treated with an increase in oral prednisone or a change in calcineurin inhibitor agent (CsA to TAC). 6% of LAR episodes were ST resistant and required OKT3. LAR treated with maintenance cyclosporine compared with tacrolimus, 28% vs 14%, respectively (p=0.006).
Junge, G. et al. 20053	N/A	Corticoid bolus therapy was prescribed in 39 patients (81%). Of all the patients with grade 0.5 rejections, 28% (n=7) received a modification of their immunosuppression. AR higher than grade 1 was treated with ST bolus therapy (11%) or a modification of their immunosuppression (30%).
Florman, S. et al. 20042	CsA target levels (ng/dL) were routinely maintained post-LT between 300 and 400 the first month, 250 and 350 the second and third months, 200 and 300 between months 3 and 12, and 100 and 200 after 1 year. TAC target levels (ng/dL) were routinely maintained post-LT between 15 and 20 the first month, 10 and 15 between the second and third months, approximately 10 between 3 and 12 months, and between 5 and 10 after 1 year.	Intravenous ST boluses ± intravenous ST recycle; Over five days (50 mg, then 40 mg, then 30 mg, then 20 mg, then 20 mg, then changed to 20 mg daily orally) for this initial LAR. OKT3 in few cases.
Uemura, T. et al. 2008 9	TAC or CsA with ST. Renal dysfunction or other calcineurin toxicity received azathioprine at 1-2 mg/kg/d (1984-1994) or MMF at 0.5-2 g/d (1995-2004). ST taper was used in all patients. Induction therapy with OKT3 was used in only patients with pre-existing renal failure at the time of transplant. CsA target levels (ng/mL) were routinely maintained post-LT between 250 and 350 in the first month and tapered down to 100 and 200 after one year.	Intravenous bolus of 1 g of methylprednisolone daily for two days followed by recycles of prednisolone. If clinical and histological evidence of persistent acute rejection remained, OKT3 or thymoglobulin was administered intravenously for a total of seven to 14 day followed by a liver biopsy.
Thurairajah, P.H. et al. 2013 7	24 patients (24%) were on monotherapy with a calcineurin inhibitor (21 on TAC and 3 on CsA), 56 patients (57%) were on two immunosuppressors, with the most common combination consisting of an antimetabolite and a CNI (19 azathioprine and TAC, 16 TAC and MMF), 9 patients were on prednisolone and TAC and 18 patients (18%) were on a triple-therapy regimen of CNI, antimetabolites, and corticosteroids.	Pulsed high-dose corticosteroids prednisolone 200 mg/day for three days.
Akamatsu, N. et al. 2006 1	ST and TAC strictly controlled with therapeutic drug monitoring. More than 6 months after LDLT, TAC and CsA were maintained at 5 to 10 μg/L and 100 to 150 μg/L, respectively.	High-dose methylprednisolone (20 mg/kg per day) followed by recycling. Patients with steroid-resistant cellular rejection were treated with MMF and OKT3.

CsA=cyclosporine; OKT3=anti-T-cell monoclonal antibody; MMF=mycophenolate mofetil; LAR=late acute rejection; AR=acute rejection; EAR=early acute rejection; LT=liver transplantation; LDLT=liver donor liver transplantation; ST=steroid; Bx=biopsy; CR=chronic rejection; TAC=tacrolimus; N/A=not applicable