The only non-invasive blood-based test that assists in lowering immunosuppression in liver transplant patients.

TruGraf® Liver Confirms Immune Quiescence and Offers Biomarker Guidance for Immunosuppression


Lowering immunosuppression reduces risk of renal impairment by 50%


Up to 60% of patients can benefit from lowering immunosuppression

Is biomarker-guided immunosuppression minimization right for your patient?

Until now, immunosuppression minimization has largely been a “trial and error” process, with clinicians relying on overt signs of rejection as indicators of immune activation. TruGraf Liver offers biomarker-based monitoring to guide immunosuppression minimization, either routine or as indicated while avoiding graft injury.

Published Data Shows

  • Development of acute rejection is the most significant limitation to immunosuppression minimization.
  • Immunosuppression minimization or even full immunosuppression withdrawal may be feasible in select patients.
  • Lowering calcineurin-based nephrotoxin immunosuppression may help prevent chronic kidney disease; also overall reduction in immunosuppression provides long term benefits, including improvements in hyperlipidemia, glycemic control, hypertension, weight gain, and reduced risk of malignancy.
  • Lowering immunosuppression without the guidance of TruGraf Liver as a biomarker of immune quiescence can lead to under-immunosuppression and acute liver rejection.
  • Minimizing immunosuppression medications increases patient adherence and decreases patient cost.

Indications & Contraindications for Use

The TruGraf Liver test is intended for use in liver transplant patients who are the recipient of a primary deceased or living donor allograft and who are at least 18 years old, to guide immunosuppression minimization.

Physicians should use the TruGraf Liver test for serial monitoring of patients to confirm immune quiescence during immunosuppression minimization, beginning one month post liver transplantation.

TruGraf Liver has not yet been studied sufficiently in the following patient populations:

  • recipients of previous or multi-organ transplants
  • recipients infected with HIV


  1. Levitsky, J, Asrani, SK, Schiano, T, et al.; for the Clinical Trials in Organ Transplantation – 14 Consortium. Discovery and validation of a novel blood-based molecular biomarker of rejection following liver transplantation. Am J Transplant. 2020; 20: 2173– 2183.
  2. Levitsky, J, et al. Investigator assessment of the clinical utility of a novel blood-based biomarker of liver transplant rejection.
  3. Benitez C, Londono M, et al. Prospective multicenter clinical trial of immunosuppressive drug withdrawal in stable adult liver transplant recipients. Hepatology. 2013 Nov;58(5):1824-1835.
  4. Charlton M, Levitsky J, et al. International Liver Transplantation Society consensus statement on immunosuppression in liver transplant recipients. Transplantation. 2018 May;102(5): 727-743.
  5. Shaked A, DesMarais M.R., et al. Outcomes of immunosuppression minimization and withdrawal early after liver transplantation. Am J Transplant. 2019 May;19(5):1397-1409.