Immunosuppression for the Transplant Surgical Patient

Abstract

Immunosuppression brings with it many additional challenges in the management of the surgical patient already fraught with complexity. Given advances in surgery and medicine, transplantation has become a therapeutic option for patients once considered too ill. In the medical management of these patients, it is always most important to take into account the clinical status of the patient to balance the risk of infection and rejection. The management of immunosuppression in the surgical patient is challenging depending on the clinical scenario. In addition to patient-specific factors, there are many medication-related factors to consider, including toxicity, interactions, and pharmacokinetics. It is always important to consult a transplant specialist prior to initiating or reinitiating immunosuppression in these patients as the therapeutic goals are likely to be modified. Additionally, consideration of the patient’s history as it pertains to infection, rejection, and malignancy is highly pertinent in their immunosuppression management. Appropriate management and augmentation of immunosuppression are critical to the success of these patients, both at the time of transplantation and in the years that follow. The goal of this review is to provide a basis for the understanding of the complexities of immunosuppression in the surgical transplant patient. This review contains 5 figures, 7 tables, and 54 references. Key Words: immunosuppression; infection; rejection; solid-organ transplantation