ABSTRACT
An expanding array of agents are being developed for the treatment of autoimmune,
inflammatory, and dermatological conditions and to prevent rejection following solid organ
transplantation. Indeed, the search for novel immunosuppressant and immunomodulatory
agents that are effective and well tolerated is currently amongt the most active areas of
pharmaceutical research and development. Although the currently available immunosuppres-
sant and immunomodulatory drugs have generally well-defined toxicities, hepatotoxicity is
being increasingly recognized with some of these agents. Nonetheless, severe liver injury from
these drugs is generally rare, appearing infrequently in several large surveys of drug-induced
liver injury (1-4). Immunosuppressant-related liver injury represents an apparent paradox
because it is generally well accepted that the innate and adaptive immune systems participate
in the genesis and evolution of most if not all forms of liver injury (5,6). Indeed, most of the
immunosuppressants described in this chapter have been used at least in the context of clinical
trials for the treatment of liver disease. For example, uncontrolled studies report a potentially
beneficial effect from corticosteroid therapy for some causes of drug-induced liver injury,
particularly if there are autoimmune or hypersensitivity features (7).
