Conference recommendations on immunosuppression practice for adult liver transplantation in Egypt

Abstract Background Adult living donor liver transplantation (LDLT) started in Egypt in 2001, with more than 5000 cases transplanted since then. In Egypt using only ABO compatible donor is the practice in all cases, and up till now, the only oncological indication for LDLT is hepatocellular carcinoma (HCC). The optimal management of the transplant recipient relies on understanding and proper utilization of immunosuppression regimens. The clinician should be aware of how to maintain the delicate balance between under-immunosuppression, leading to graft rejection, and over-immunosuppression, leading to the consequences of immunodeficiency such as sepsis and malignancy. The aim of this consensus is to provide clinical guidance to transplant physicians, transplant surgeons, clinical pharmacologists and nurses about immunosuppression in LDLT recipients. Main body These national recommendations on immunosuppression in adult LDLT were developed by an experience exchange between the 22 centers currently undergoing LDLT in Egypt. A group of experts in liver transplantation from all over Egypt participated in the review of literature for different aspects related to these recommendations and, then they shared in formulation of several statements. In the United Conference on Hepato-gastroenterology and Infectious Diseases (UCHID) (2022), voting on these statements was done. Conclusion Comprehensive national guidance is provided regarding the general principles of liver transplant immunosuppression, types of immunosuppression (IS), established IS drugs, types of rejection and their management, treatment of special groups, immunosuppression minimization, immune tolerance and complete IS withdrawal and the role of liver biopsy in orchestrating immunosuppression.