Ramos, H and Reyes, J and Abu-Elmagd, K and Zeevi, A and Reinsmoen, N and Tzakis, A and Demetris, AJ and Fung, JJ and Flynn, B and McMichael, J and Ebert, F and Starzl, TE
(1995)
Weaning of immunosuppression in long - Term liver transplant recipients.
Transplantation, 59 (2).
212 - 217.
ISSN 0041-1337
Abstract
Seventy-two long-surviving liver transplant recipients were evaluated prospectively, including a baseline allograft biopsy for weaning off of immunosuppression. Thirteen were removed from candidacy because of chronic rejection (n=4), hepatitis (n=2), patient anxiety (n=5), or lack of cooperation by the local physician (n=2). The other 59, aged 12-68 years, had stepwise drug weaning with weekly or biweekly monitoring of liver function tests. Their original diagnoses were PBC (n=9), HCC (n=l), Wilson’s disease (n=4), hepatitides (n=15), Laennec’s cirrhosis (n=l), biliary atresia (n=16), cystic fibrosis (n=l), hemochromatosis (n=l), hepatic trauma (n=l), alpha-l-antitrypsin deficiency (n=9), and secondary biliary cirrhosis (n=l). Most of the patients had complications of long-term immunosuppression, of which the most significant were renal dysfunction (n=8), squamous cell carcinoma (n=2) or verruca vulgaris of skin (n=9), osteoporosis and/or arthritis (n=12), obesity (n=3), hypertension (n=ll), and opportunistic infections (n=2). When azathioprine was a third drug, it was stopped first. Otherwise, weaning began with prednisone, using the results of corticotropin stimulation testing as a guide. If adrenal insufficiency was diagnosed, patients reduced to <5 mg/day prednisone were considered off of steroids. The baseline agents (azathioprine, cyclospo-rine, or FK506) were then gradually reduced in monthly decrements. Complete weaning was accomplished in 16 patients (27.1%) with 3-19 months drug-free follow-up, is progressing in 28 (47.4%), and failed in 15 (25.4%) without graft losses or demonstrable loss of graft function from the rejections. This and our previous experience with self-weaned and other patients off of immunosuppression indicate that a significant percentage of appropriately selected long-surviving liver recipients can unknowingly achieve drug-free graft acceptance. Such attempts should not be contemplated until 5-10 years posttransplantation and then only with careful case selection, close monitoring, and prompt reinstitution of immunosuppression when necessary. © 1995 by Williams & Wilkins.
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| Item Type: |
Article
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| Status: |
Published |
| Creators/Authors: |
| Creators | Email | Pitt Username | ORCID  |
|---|
| Ramos, H | | | | | Reyes, J | | | | | Abu-Elmagd, K | | | | | Zeevi, A | | | | | Reinsmoen, N | | | | | Tzakis, A | | | | | Demetris, AJ | | | | | Fung, JJ | | | | | Flynn, B | | | | | McMichael, J | | | | | Ebert, F | | | | | Starzl, TE | tes11@pitt.edu | TES11 | |
|
| Centers: |
Other Centers, Institutes, Offices, or Units > Thomas E. Starzl Transplantation Institute |
| Date: |
1 January 1995 |
| Date Type: |
Publication |
| Journal or Publication Title: |
Transplantation |
| Volume: |
59 |
| Number: |
2 |
| Page Range: |
212 - 217 |
| DOI or Unique Handle: |
10.1097/00007890-199501270-00010 |
| Institution: |
University of Pittsburgh |
| Refereed: |
Yes |
| ISSN: |
0041-1337 |
| Other ID: |
uls-drl:31735062125061, Starzl CV No. 1631 |
| Date Deposited: |
08 Apr 2010 17:27 |
| Last Modified: |
04 Feb 2019 15:57 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/5017 |
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