过去几十年来，外科手术和免疫抑制疗法的进步大大改善了接受肝移植的患者的预后。 2020 年，意大利肝移植工作组发布了针对成人肝移植 (LT) 受者的免疫抑制治疗 (IT) 的面向实践的算法。由于 LT 领域快速发展，需要定期更新建议。本次审查提出了 2020 年建议的共识和基于证据的更新。意大利肝移植工作组着手解决新的 IT 问题，这些问题是根据支持文献和专家的个人经验进行讨论的。在达成共识之前，专家组对每项声明进行了审议和评分。制定并最终确定了一系列共识声明：(i) LT 的肿瘤学适应症； (ii) 慢性 LT 排斥反应的处理； (iii) 肝肾联合移植； (iv) 循环死亡后捐献的器官移植时的免疫抑制； (v) 在虚弱和肌肉减少症的情况下进行移植； (vi) 捐献者和受赠者之间的 ABO 血型不相容。以下 LT 组的算法已更新：标准患者、危重患者、肿瘤患者、具有特定病因的患者和高免疫风险患者。除患有自身免疫性肝病和免疫学高风险的患者外，通常建议采用无类固醇治疗方法。针对 ABO 相容性 LT 成年患者的免疫抑制方案，最新的 2024 年共识和循证建议解决了一系列临床变量应考虑优化意大利临床实践中免疫抑制治疗的选择。© 2024。作者。

Advances in surgical procedures and immunosuppressive therapies have considerably improved the outcomes of patients who have undergone liver transplantation in the past few decades. In 2020, the Italian Liver Transplant Working Group published practice-oriented algorithms for immunosuppressive therapy (IT) in adult liver transplant (LT) recipients. Due to the rapidly evolving LT field, regular updates to the recommendations are required. This review presents a consensus- and evidence-based update of the 2020 recommendations.The Italian Liver Transplant Working Group set out to address new IT issues, which were discussed based on supporting literature and the specialists' personal experiences. The panel deliberated on and graded each statement before consensus was reached.A series of consensus statements were formulated and finalized on: (i) oncologic indications for LT; (ii) management of chronic LT rejection; (iii) combined liver-kidney transplantation; (iv) immunosuppression for transplantation with an organ donated after circulatory death; (v) transplantation in the presence of frailty and sarcopenia; and (vi) ABO blood group incompatibility between donor and recipient. Algorithms were updated in the following LT groups: standard patients, critical patients, oncology patients, patients with specific etiology, and patients at high immunologic risk. A steroid-free approach was generally recommended, except for patients with autoimmune liver disease and those at high immunologic risk.The updated consensus- and evidence-based 2024 recommendations for immunosuppression regimens in adult patients with ABO-compatible LT address a range of clinical variables that should be considered to optimize the choice of the immunosuppression treatment in clinical practice in Italy.© 2024. The Author(s).