The increasing potency of immunosuppression (IS) agents resulted in significantly decreased rates of steroid resistant rejection and rejection related graft loss in liver transplantation (LT). Currently, more than two thirds of late mortality after LT is unrelated to graft function. However, the increased benefit of more potent IS drugs, coupled with the prolonged survival of transplant recipients led to longer patients exposure to these drugs and their unwanted adverse effects, creating a double-edged sword.

In this article the authors describe the mechanism of action and the adverse effects of the most commonly used immunosuppressed drugs, and the most commonly used IS regimens for both induction and maintenance regimens.

The balance between the ideal IS regimen to prevent rejection and the need to minimize the dose of IS drugs in order to prevent the adverse effects related to its use requires the knowledge of the science and the experience with the art of medicine. The different protocols aimed at protecting renal function and preventing the development of de novo cancer and metabolic syndrome are discussed here.

The main causes of mortality late after liver transplant are associated with prolonged use of IS medications, and clear evidence exists about over-immunosuppression of recipients of liver transplant. The current status of strategies of IS minimization and withdrawal are reviewed in this article, with evaluation of its benefits and pitfalls.

免疫抑制（IS）剂效力的提高导致在肝移植（LT）中类固醇抵抗排斥和与排斥相关的移植物损失的速率大大降低。目前，LT后晚期死亡的三分之二以上与移植物功能无关。然而，更有效的IS药物的益处增加，再加上移植受者的生存期延长，导致患者更长的时间接触这些药物及其不良副作用，从而造就了一把双刃剑。

在本文中，作者描述了最常用的免疫抑制药物以及诱导和维持方案中最常用的IS方案的作用机理和不良反应。

防止排斥的理想IS方案与最小化IS药物剂量以防止与其使用相关的不良影响之间的平衡需要了解科学知识和医学领域的经验。本文讨论了旨在保护肾脏功能和预防新生癌症和代谢综合征发展的不同方案。

肝移植术后晚期死亡的主要原因与长期使用IS药物有关，并且有明确的证据表明肝移植接受者过度免疫抑制。本文回顾了IS最小化和撤回策略的当前状态，并评估了其优势和陷阱。