BACKGROUND: Some reported studies have indicated the possibility of immunosuppression withdrawal in cadaveric liver transplantation. The aim of this study was to evaluate the possibility and feasibility of weaning living donor liver transplant recipients from immunosuppression. METHODS: From June of 1990 to October of 1999, 63 patients were considered to be weaned from immunosuppression. They consisted of 26 electively weaned patients and 37 either forcibly or incidentally weaned patients (nonelective weaning) due to various causes but mainly due to infection. Regarding elective weaning, we gradually reduced the frequency of tacrolimus administration for patients who survived more than 2 years after transplantation, maintained a good graft function, and had no rejection episodes in the preceding 12 months. The frequency of administration was reduced from the conventional b.i.d. until the start of weaning to q.d., 4 times a week, 3 times a week, twice a week, once a week, twice a month, once a month, and finally, the patients were completely weaned off with each weaning period lasting from 3 to 6 months. The reduction method of nonelective weaning depended on the clinical course of each individual case. When the patients were clinically diagnosed to develop rejection during weaning, then such patients were treated by a reintroduction of tacrolimus or an additional steroid bolus when indicated. RESULTS: Twenty-four patients (38.1%) achieved a complete withdrawal of tacrolimus with a median drug-free period of 23.5 months (range, 3-69 months). Twenty-three patients (36.5%) are still being weaned at various stages. Sixteen patients (25.4%) encountered rejection while weaning at median period of 9.5 months (range, 1-63 months) from the start of weaning. All 16 were easily treated with the reintroduction of tacrolimus or additional steroid bolus therapy. CONCLUSIONS: We were able to achieve a complete withdrawal of immunosuppression in some selected patients. Although the mechanism of graft acceptance in these patients has yet to be elucidated, we believe that a majority of long-term patients undergoing living donor liver transplantation may, thus, be potential candidates to be successfully weaned from immunosuppression.
BACKGROUND: Some reported studies have indicated the possibility of immunosuppression withdrawal in cadaveric liver transplantation. The aim of this study was to evaluate the possibility and feasibility of weaning living donor liver transplant recipients from immunosuppression. METHODS: From June of 1990 to October of 1999, 63 patients were considered to be weaned from immunosuppression. They consisted of 26 electively weaned patients and 37 either forcibly or incidentally weaned patients (nonelective weaning) due to various causes but mainly due to infection. Regarding elective weaning, we gradually reduced the frequency of tacrolimus administration for patients who survived more than 2 years after transplantation, maintained a good graft function, and had no rejection episodes in the preceding 12 months. The frequency of administration was reduced from the conventional b.i.d. until the start of weaning to q.d., 4 times a week, 3 times a week, twice a week, once a week, twice a month, once a month, and finally, the patients were completely weaned off with each weaning period lasting from 3 to 6 months. The reduction method of nonelective weaning depended on the clinical course of each individual case. When the patients were clinically diagnosed to develop rejection during weaning, then such patients were treated by a reintroduction of tacrolimus or an additional steroid bolus when indicated. RESULTS: Twenty-four patients (38.1%) achieved a complete withdrawal of tacrolimus with a median drug-free period of 23.5 months (range, 3-69 months). Twenty-three patients (36.5%) are still being weaned at various stages. Sixteen patients (25.4%) encountered rejection while weaning at median period of 9.5 months (range, 1-63 months) from the start of weaning. All 16 were easily treated with the reintroduction of tacrolimus or additional steroid bolus therapy. CONCLUSIONS: We were able to achieve a complete withdrawal of immunosuppression in some selected patients. Although the mechanism of graft acceptance in these patients has yet to be elucidated, we believe that a majority of long-term patients undergoing living donor liver transplantation may, thus, be potential candidates to be successfully weaned from immunosuppression.
Authors: Thomas E Starzl; Noriko Murase; Kareem Abu-Elmagd; Edward A Gray; Ron Shapiro; Bijan Eghtesad; Robert J Corry; Mark L Jordan; Paulo Fontes; Tim Gayowski; Geoffrey Bond; Velma P Scantlebury; Santosh Potdar; Parmjeet Randhawa; Tong Wu; Adriana Zeevi; Michael A Nalesnik; Jennifer Woodward; Amadeo Marcos; Massimo Trucco; Anthony J Demetris; John J Fung Journal: Lancet Date: 2003-05-03 Impact factor: 79.321
Authors: Thomas E Starzl; Noriko Murase; Anthony J Demetris; Massimo Trucco; Kareem Abu-Elmagd; Edward A Gray; Bijan Eghtesad; Ron Shapiro; Amadeo Marcos; John J Fung Journal: Transplantation Date: 2004-03-27 Impact factor: 4.939
Authors: Pervinder Sagoo; Esperanza Perucha; Birgit Sawitzki; Stefan Tomiuk; David A Stephens; Patrick Miqueu; Stephanie Chapman; Ligia Craciun; Ruhena Sergeant; Sophie Brouard; Flavia Rovis; Elvira Jimenez; Amany Ballow; Magali Giral; Irene Rebollo-Mesa; Alain Le Moine; Cecile Braudeau; Rachel Hilton; Bernhard Gerstmayer; Katarzyna Bourcier; Adnan Sharif; Magdalena Krajewska; Graham M Lord; Ian Roberts; Michel Goldman; Kathryn J Wood; Kenneth Newell; Vicki Seyfert-Margolis; Anthony N Warrens; Uwe Janssen; Hans-Dieter Volk; Jean-Paul Soulillou; Maria P Hernandez-Fuentes; Robert I Lechler Journal: J Clin Invest Date: 2010-05-24 Impact factor: 14.808
Authors: Kenneth A Newell; Adam Asare; Allan D Kirk; Trang D Gisler; Kasia Bourcier; Manikkam Suthanthiran; William J Burlingham; William H Marks; Ignacio Sanz; Robert I Lechler; Maria P Hernandez-Fuentes; Laurence A Turka; Vicki L Seyfert-Margolis Journal: J Clin Invest Date: 2010-05-24 Impact factor: 14.808
Authors: Patrick G Northup; Michael M Abecassis; Michael J Englesbe; Jean C Emond; Vanessa D Lee; George J Stukenborg; Lan Tong; Carl L Berg Journal: Liver Transpl Date: 2009-02 Impact factor: 5.799