IMMUNOSUPPRESSION FOR LIVER TRANSPLANTATION

T.M. Manzia¹, R. Angelico¹, L. Toti¹, M. Manuelli¹, I. Bellini¹, D. Sforza¹, L. Perrone¹, G. Tisone^2
1Transplant Unit, Tor Vergata University, Rome/ITALY, ²General And Transplant Surgery, Tor Vergata University of Rome, Rome/ITALY

Body: Background/Aims: Immunosuppressive drugs (IS) can be completely withdrawn in up to 20% of liver transplant recipients, commonly referred to as 'operationally' tolerant. Nowadays we lack of factorsidentifying tolerant patients among liver recipients. Aim of our study was to identify predictors of an immunosuppression-free state Methods: Twenty nine liver transplant recipients (mean age:48.4±9.1 years) transplanted 109.6±47.36 months earlier were enrolled in a prospective study with the aim to stop IS. Indication for liver transplantation (LT) were end stage livercirrhosis in 26 (89.6%)pts, HCC in one(3.4%) and ALF in two (7%). Immediately after transplantation, all recipients were under calcineurin inhibitors (CNI)[18(62%) under cyclosporine A (CsA) and 10(29%) under tacrolimus]. At the time of weaning protocol, nine(31%) were under mycophenolate mofetil (MMF) and 20(69%) remained under CNI. All patients underwent liver biopsy before entry, after 12months IS withdrawal and when rejection was suspected. Patients were checked every 4 weeks and immunosuppressive drugs have been gradually discontinued with the aim to complete withdrawal by month 12after initiation of the study. Following drug discontinuation, patients have been followed every 4 weeks for 12 months. Liver function tests (LFTs) have been obtained at every clinical follow-up.Results: Complete and permanent immunosuppression withdrawal was achieved in 14 patients (48.2%) whereas one (3.6%) had LFTs deterioration (without sign of acute rejection at liver biopsy) at threemonths after discontinuation and 14 (48.2%) experienced LFTs worsening during tapering (liver biopsy shown three mild acute rejection, two moderate and no rejection in nine cases). All of them hadcomplete normalization of LFTs with IS baseline resumption. After a mean follow-up of 11.0±3.9 months weaned patients showed no difference in terms of transaminase (p=0.38), creatinine(p=0.32) and lipid profile (p=0.52). No weaned recipients experienced rejection at the 1 year biopsy. We identified CsA based IS therapy during the first post transplant week [mean blood levels:210±116.1ng/ml] (p=0.01), baseline MMF therapy (p=0.03) and longer post transplant follow-up [138.8±30.5 vs. 82.4±44.4] (One way, p=0.0001) as independent predictors of sustainedweaning. Conclusions: Achievement of weaning is possible in 50% of selected recipients and seems to be favoured by the use of CsA IS immediately after LT.

Disclosure: All authors have declared no conflicts of interest.