Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/4289541

In Collections

This item can be found in the following collections:

Ruijter, B.N. (2026)

Improving efficacy and reducing adverse effects of immunosuppression after liver transplantation

Doctoral Thesis
This thesis focuses on optimizing and individualizing immunosuppression after liver transplantation to balance graft survival with minimizing adverse effects such as infections, metabolic complications, and malignancies. The DELTA study (Chapter 2) compared ciclosporin and tacrolimus de novo after transplantation, using two-hour blood level monitoring for ciclosporin. Building on evolving practices, a new meta-analysis (Chapter 3) evaluated randomized trials (2000–2024) comparing both drugs, considering modern dosing and adjunct therapies.

The FK-04 study (Chapter 4) compared conventional trough monitoring versus four-hour tacrolimus monitoring, focusing on renal function and rejection outcomes. Beyond drug monitoring, the thesis examined viral reactivation as a marker of over-immunosuppression: Chapter 5 evaluated Epstein–Barr virus (EBV) monitoring and its role in preventing post-transplant lymphoproliferative disease (PTLD) in adults, while Chapter 6 identified...Show more This thesis focuses on optimizing and individualizing immunosuppression after liver transplantation to balance graft survival with minimizing adverse effects such as infections, metabolic complications, and malignancies. The DELTA study (Chapter 2) compared ciclosporin and tacrolimus de novo after transplantation, using two-hour blood level monitoring for ciclosporin. Building on evolving practices, a new meta-analysis (Chapter 3) evaluated randomized trials (2000–2024) comparing both drugs, considering modern dosing and adjunct therapies.

The FK-04 study (Chapter 4) compared conventional trough monitoring versus four-hour tacrolimus monitoring, focusing on renal function and rejection outcomes. Beyond drug monitoring, the thesis examined viral reactivation as a marker of over-immunosuppression: Chapter 5 evaluated Epstein–Barr virus (EBV) monitoring and its role in preventing post-transplant lymphoproliferative disease (PTLD) in adults, while Chapter 6 identified independent PTLD risk factors.

Given the infection risk from immunosuppression, Chapter 7 analyzed bacterial infections within the first year post-transplant under a standardized selective digestive decontamination (SDD) protocol. Chapter 8 integrates findings and discusses their implications for clinical practice, aiming toward more individualized, safer immunosuppressive strategies in liver transplantation.
Show less
Liver Transplantation
Optimizing immunosuppressive therapy
Adverse effects of immunosuppression
Therapeutic drug monitoring
Infections after liver transplantation
Post-transplant lymphoproliferative disease
All authors
Ruijter, B.N.
Supervisor
Hoek, B. van
Co-supervisor
Tushuizen, M.E.
Committee
Arend, S.M.; Coenraad, M.J.; Gelder, T. van: Hoed C.M. den; Meijer, V.E. de
Qualification
Doctor (dr.)
Awarding Institution
Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
Date
2026-01-13
ISBN (print)
9789493483101