Immunosuppression and vascular remodeling after liver transplantation: Mechanisms, surrogate markers, and modifiable pathways

doi:10.5500/wjt.v16.i2.118288

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Jun 18, 2026; 16(2): 118288
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.118288

Immunosuppression and vascular remodeling after liver transplantation: Mechanisms, surrogate markers, and modifiable pathways

Sarah Jahangir, Mohammed Zohery, Clarimar Diaz Lopez, Jenna Carter Hamed, Shiza Sarfraz, Hafsa Ashraf, Taha Rafiq, Hadeera Ali, Muhammad Raza, Dushyant Singh Dahiya, Mohamed Khalaf, Hassam Ali

Sarah Jahangir, Jenna Carter Hamed, Department of Medicine, East Carolina University - Brody School of Medicine, Greenville, NC 27834, United States

Mohammed Zohery, George Washington School of Medicine and Health Sciences, The George Washington University, Washington, District of Columbia 20052, United States

Clarimar Diaz Lopez, Department of Medicine, East Carolina University, Greenville, NC 27834, United States

Shiza Sarfraz, Department of Internal Medicine, East Carolina University - Brody School of Medicine, Greenville, NC 27834, United States

Hafsa Ashraf, Department of Internal Medicine, Berkshire Medical Center, Pittsfield, MA 01201, United States

Taha Rafiq, Department of Medicine, University of Galway, Galway TK33, Ireland

Hadeera Ali, Department of Medicine, Combined Military Hospital, Bahawalpur 63100, Punjab, Pakistan

Muhammad Raza, Department of Medicine, Combined Military Hospital, Lahore 54000, Punjab, Pakistan

Dushyant Singh Dahiya, Division of Gastroenterology, Hepatology, and Motility, The University of Kansas School of Medicine, Kansas City, KS 66160, United States

Mohamed Khalaf, Division of Gastroenterology and Hepatology, Medical University of South Carolina, Charleston, SC 29401, United States

Hassam Ali, Division of Gastroenterology, Hepatology and Nutrition, East Carolina University - Brody School of Medicine, Greenville, NC 27834, United States

Co-first authors: Sarah Jahangir and Mohammed Zohery.

Author contributions: Jahangir S, Zohery M, Diaz Lopez C, Hamed JC, Sarfraz S, Ashraf H, Rafiq T, Ali H, Raza M, Dahiya DS, and Khalaf M contributed to literature review, data synthesis, and drafting of the manuscript, including figures preparation; Dahiya DS, Khalaf M, and Ali H critically revised the manuscript for important intellectual content; Ali H conceived the review topic, supervised manuscript development, and coordinated revisions; Jahangir S and Zohery M contributed equally to this manuscript and are co-first authors. All authors reviewed and approved the final version of the manuscript.

AI contribution statement: Grammarly was used during the preparation of this manuscript for grammar checking and language refinement, which may have included AI-assisted suggestions for sentence restructuring and rephrasing.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Corresponding author: Hassam Ali, MD, Division of Gastroenterology, Hepatology and Nutrition, East Carolina University - Brody School of Medicine, 2100 Statonsburg Road, Greenville, NC 27834, United States. hassamali155@gmail.com

Received: December 29, 2025
Revised: February 2, 2026
Accepted: March 11, 2026
Published online: June 18, 2026
Processing time: 152 Days and 4.6 Hours

Core Tip

Core Tip: Long-term survival after liver transplantation is increasingly limited by cardiovascular disease driven by immunosuppression-associated vascular remodeling. This review highlights how commonly used immunosuppressive agents, particularly calcineurin inhibitors and corticosteroids, promote endothelial dysfunction, arterial stiffening, and metabolic injury, while alternative strategies such as mammalian target of rapamycin inhibitor-based regimens and antimetabolites may reduce vascular harm. We emphasize noninvasive vascular markers and individualized immunosuppression as emerging tools to balance graft protection with long-term cardiovascular health in liver transplant recipients.