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Weaning of immunosuppression in long - Term liver transplant recipients

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

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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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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Ramos, H
Reyes, J
Abu-Elmagd, K
Zeevi, A
Reinsmoen, N
Tzakis, A
Demetris, AJ
Fung, JJ
Flynn, B
McMichael, J
Ebert, F
Starzl, TEtes11@pitt.eduTES11
Centers: Other Centers, Institutes, 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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