{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T14:42:52Z","timestamp":1778769772354,"version":"3.51.4"},"reference-count":48,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2022,2,24]],"date-time":"2022-02-24T00:00:00Z","timestamp":1645660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The optimal immunosuppression protocol to prevent early acute cellular rejection (ACR) after liver transplantation (LT) avoiding prolonged hospitalization and early hospital readmission is undefined.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To identify the most suitable immunosuppression regimen for inclusion in ERAS programs in order to minimize early ACR after LT and to provide expert panel recommendations<\/jats:p><\/jats:sec><jats:sec><jats:title>Data sources<\/jats:title><jats:p>Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Systematic review following PRISMA guidelines and recommendations using the GRADE approach derived from an international expert panel. Studies from January 2000 onward focusing on early ACR were included. Rates of early renal dysfunction and infection were evaluated. CRD42021245586<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010seven studies met inclusion criteria; 23 randomized controlled trials, 14 retrospective or prospective observational comparative or noncomparative studies. Several sources of biases which potentially confound conclusions were identified: heterogeneity in immunosuppression protocols, higher serum tacrolimus levels than currently used in clinical practice, differences in the definition of ACR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Tacrolimus is the standard immunosuppression after LT and can be used in combination with other drugs such as corticosteroids and MMF, and in association with anti\u2010IL2 receptor antibody (IL2Ra) induction. <jats:bold>(Quality of Evidence; Low | Grade of Recommendation; Strong)<\/jats:bold>. Low dose or delayed introduction of tacrolimus in association with corticosteroids and MMF and\/or anti\u2010IL2Ra induction can be used to reduce acute kidney injury. <jats:bold>(Quality of Evidence; Low | Grade of Recommendation; Strong)<\/jats:bold>. Use of tacrolimus in association with corticosteroids and MMF and\/or anti\u2010IL2Ra induction does not lead to increased infection rates. <jats:bold>(Quality of Evidence; Low | Grade of Recommendation; Weak)<\/jats:bold><\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14614","type":"journal-article","created":{"date-parts":[[2022,2,10]],"date-time":"2022-02-10T16:53:55Z","timestamp":1644512035000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["The optimal immunosuppression management to prevent early rejection after liver transplantation: A systematic review of the literature and expert panel recommendations"],"prefix":"10.1111","volume":"36","author":[{"given":"Eleonora","family":"De Martin","sequence":"first","affiliation":[{"name":"APHP H\u00f4pital Paul Brousse Centre H\u00e9pato\u2010Biliaire INSERM Unit 1193, FHU Hepatinov  Villejuif France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria\u2010Carlota","family":"Londo\u00f1o","sequence":"additional","affiliation":[{"name":"Liver Unit Hospital Clinic Institut d'Investigacions Biom\u00e8diques August Pi I Sunyer and Centro de Investigaci\u00f3n en Red de Enfermedades Hep\u00e1ticas y Digestivas University of Barcelona  Barcelona Catalonia Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juliet","family":"Emamaullee","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Southern California  Los Angeles USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jan","family":"Lerut","sequence":"additional","affiliation":[{"name":"Institute for Experimental and Clinical Research (IREC) Universit\u00e9 catholique Louvain (UCL)  Brussels Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan","family":"Potts","sequence":"additional","affiliation":[{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Varuna","family":"Aluvihare","sequence":"additional","affiliation":[{"name":"Transplant Hepatology Lead Institute of Liver Studies King's College Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Spiro","sequence":"additional","affiliation":[{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"},{"name":"Department of Anesthesia and Intensive Care Medicine Royal Free Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dimitri Aristotle","family":"Raptis","sequence":"additional","affiliation":[{"name":"Clinical Service of HPB Surgery and Liver Transplantation Royal Free Hospital  London UK"},{"name":"Division of Surgery and Interventional Science University College London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Geoffrey","family":"McCaughan","sequence":"additional","affiliation":[{"name":"A.W. 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