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.
B.N. Ruijter (Thu,) studied this question.