Immunosuppressive agents in liver transplantation

Agent	Mechanism of action	Selected adverse effects*
Prednisone	Suppresses leukocyte, macrophage, and cytotoxic T-cell activity Decreases cytokines, prostaglandins, and leukotrienes	Hypertension Dyslipidemia Glucose intolerance Bone abnormalities Peptic ulcers Psychiatric disorders
Cyclosporine	Inactivates calcineurin Decreases IL-2 production Inhibits T-cell activation	Hypertension Renal insufficiency Neuropathy Hyperlipidemia Gingival hyperplasia Hirsutism Insulin resistance
Tacrolimus	Inactivates calcineurin Decreases IL-2 production Inhibits T-cell activation	Hypertension Renal insufficiency Insulin resistance Neuropathy Hyperlipidemia
Azathioprine or 6-mercaptopurine	Inhibits adenosine and guanine production Inhibits DNA and RNA synthesis in rapidly proliferating T cells	Leukopenia Anemia Thrombocytopenia Pancreatitis
Mycophenolate mofetil or mycophenolic acid	Inhibits production of inosine monophosphate dehydrogenase (IMPDH) Prevents T and B cell proliferation	Leukopenia Anemia Thrombocytopenia GI side effects
Sirolimus or everolimus	Inhibits mTOR, (target of Rapamycin) Prevents T-cell replication	Leukopenia Thrombocytopenia Anemia (microcytic) Hyperlipidemia Hepatic artery thrombosis Inhibited wound healing Peripheral edema Pulmonary toxicity

* Not a complete list of adverse effects. See individual Lexicomp drug monographs for additional information.

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