IMMUNOSUPPRESSION FOR LIVER TRANSPLANTATION

P. Tryphonopoulos¹, P. Ruiz², S. Nishida³, D. Weppler⁴, D. Levi³, J. Moon³, G. Selvaggi³, E. Island⁵, A. Tekin³, M. Torres⁶, T. Defranc⁷, A. De bonnefon⁶, L. Arosemena⁶, A. Tzakis^3
1Surgery Transplant, University of Miami, Miami/FL/UNITED STATES OF AMERICA, ²Pathology, UNIVERSITY OF MIAMI, MIAMI/FL/UNITED STATES OF AMERICA, ³Surgery, UNIVERSITY OF MIAMI, MIAMI/UNITED STATES OF AMERICA, ⁴, University of Miami, Miami/FL/UNITED STATES OF AMERICA, ⁵Surgery, UNIVERSITY OF MIAMI, MIAMI/FL/UNITED STATES OF AMERICA, ⁶, University of Miami, Miami/UNITED STATES OF AMERICA, ⁷Surgery Transplant, University of Miami, Miami/UNITED STATES OF AMERICA

Body: Introduction: We present our experience with C1H induction immunosuppression in adult non-HCV liver transplant recipients Methods: From December ‘01-December ‘08, we administered C1H induction immunosuppression in 203 non-HCV liver transplant patients (Group 1, G1). Patients transplanted until April 04, received 4 doses of C1H (n=74), between April ’04 and May’05, 2 doses of C1H and after May’05, a single dose of C1H. We compared the results of these patients with a cohort of 106 non-HCV patients that were transplanted in our center during the same period of time without C1H induction (Group 2, G2). Most of these patients were transplanted during the introduction of C1H use in our program and had declined to receive the medication. Results: Follow up was until December 2009. Patient and graft survival were similar in the two groups G1 vs G2 (86.9% vs 82.3% and 80.4% vs 75.6% respectively). Freedom from all rejections (biopsy proven and clinically suspected) was 52% vs 35.44% in G1 vs G2 respectively (p=0.002). Average time to first rejection episode was also different: 2.94 vs 1.6 months in G1 vs G2 respectively (p=0.008). In the C1H group (G1) time to first rejection coincided with the time of lymphocyte repopulation in the peripheral blood. 126 patients in G1 did not receive any steroids until the end of the follow up period. Maintenance Immunosuppression: Tacrolimus trough levels were by design half the usual in G1 with levels of less than 5 ng/ml after 3 years post transplantation. 27.25% of patients in G1 vs 56.9% of patients in G2 were partially or completely converted to another immunosuppressive agent most commonly due to rejection or nephrotoxicity (p=0.00001). Freedom from renal replacement (kidney transplant or dialysis was 94.31% vs 93.12% in G1 vs G2 respectively, (p=0.7).Two patients in G1 were weaned off immunosuppression for a period of 10 months and 8 months respectively, 3 and 7 years post-transplantation. Conclusions: C1H induction in non-HCV patients is an effective regimen. The timing and dosing of its administration at the immediate transplant period does not affect the clinical outcome so far.

Disclosure: All authors have declared no conflicts of interest.