Immunosuppression after organ transplantation: Essentials

Patients who have undergone a transplantation have a significantly increased risk of developing a malignancy compared to the normal population. The risk of tumour development depends mainly on the type of the transplanted organ, the dose and duration of immunosuppression, as well as the patient's medical history, and may require individualised pre-transplant and post-transplant care. Standard immunosuppression is usually based on a combination of tacrolimus with mycophenolic acid/enteric-coated mycophenolic acid or, more rarely, a mTor inhibitor. Induction therapy may allow baseline immunosuppression to be delayed and/or started at a reduced dose. The most frequent long-term complications after liver transplantation include calcineurin inhibitor-associated nephrotoxicity; in addition, transplanted patients have an increased cardiovascular (kidney transplantation), infection and tumour risk (liver, kidney transplantation), depending on the time course after transplantation and the type of immunosuppression. To minimise long-term complications, individualised immunosuppression is recommended, taking comorbidities into account.