IMMUNOSUPPRESSION FOR LIVER TRANSPLANTATION

P. Tryphonopoulos¹, P. Ruiz², D. Weppler³, D. Levi⁴, S. Nishida⁴, J. Moon⁴, G. Selvaggi⁴, A. Tekin⁴, E. Island⁵, M. Torres⁶, A. Tzakis^4
1Surgery-transplant, University of Miami, Miami/UNITED STATES OF AMERICA, ²Pathology, UNIVERSITY OF MIAMI, MIAMI/FL/UNITED STATES OF AMERICA, ³, University of Miami, Miami/FL/UNITED STATES OF AMERICA, ⁴Surgery, UNIVERSITY OF MIAMI, MIAMI/UNITED STATES OF AMERICA, ⁵Surgery, UNIVERSITY OF MIAMI, MIAMI/FL/UNITED STATES OF AMERICA, ⁶, University of Miami, Miami/UNITED STATES OF AMERICA

Body: Introduction: This is a follow up of an immunosuppression withdrawal study we previously performed. The study involved 104 liver transplant patients without autoimmune disease and stable graft function in which the immunosuppression was gradually withdrawn over a period of 3 years. Out of the 104 patients enrolled, 22 patients were successfully weaned off immunosuppression, 20 at the first attempt and 2 more during a second attempt. Methods: In this study we present the follow up of these patients after the end of the withdrawal study: We compared their results with those of the patients that had presented rejection during the withdrawal study (n=72). Follow up was until December 2009. Results: Until the end of the follow up period, operational tolerant patients were off immunosuppression for and average of 7+0.4 years. There was no difference in patient survival until the end of the follow up period compared to the rejector group. There were no re-transplants in any of the groups. There were 22 rejection episodes in the rejector group after the end of the withdrawal study: clinically suspected (n=18), biopsy proven mild (n=1) moderate (n=2) and severe (n=1). A patient in the tolerant group presented a moderate rejection episode 5.3 years after immunosuppression withdrawal, that was treated successfully. In the rejector group, 5 patients received a kidney transplant and 2 more are on dialysis, vs none in the tolerant group. Conclusions: Patients off immunosuppression present less immunosuppression related complications. Although operational tolerance can occur in selected liver transplant patients for a long period of time, it is not a permanent sate.

Disclosure: All authors have declared no conflicts of interest.