Liver Transplantation and Drug Monitoring

The liver is the most commonly transplanted major organ after the kidney. The first human liver transplant (LT) was attempted by Thomas Starzl in 1963 in Denver. The pre-LT laboratory testing is important to avoid rejection and post LT complication. Liver allograft rejection should be considered if liver biochemistry deteriorates post liver transplant. Most LT recipients require lifelong immunosuppression to maintain graft health. Where, chronic use of immunosuppressants is associated with significant side effects. Therefore, parameters like CBC, Creatinine/calculated GFR, ALT and/or AST and Albumin to be monitored regularly. Therapeutic monitoring generally involves only markers of pharmacokinetics. But new approaches are being developed for identifying the influence of pharmacogenetic and pharmacodynamic variables so as to provide for a more personalized treatment regimen.