. 2021 Sep 17;38(Suppl 2):300–317. doi: 10.1007/s12055-021-01225-x

Table 6.

Clinical considerations in the modification of immunosuppression

Clinical scenario	Management of immunosuppression	Notes
Leukopenia	• Decrease or hold anti-metabolite	• May depend on severity of leukopenia or if neutropenia is involved
Infection	• Decrease C₀ target levels of CNI and/or • Decrease or hold anti-metabolite	• May depend on severity of infection and if patient is in the intensive care unit or on vasoactive medications or respiratory support
Chronic kidney disease	• Decrease C₀ target levels of CNI and/or • Addition of mTOR inhibitor or • Conversion of CNI to belatacept
Acute or chronic liver injury	• Decrease CNI dose • Decrease mTOR inhibitor dose (if applicable)
PTLD	• Decrease C₀ target levels of CNI	• Avoid conversion to belatacept
Malignancy	• Stop anti-metabolite • Decrease C₀ target levels of CNI