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Withdrawing immunosuppression reduces HCV recurrence in transplants

Reconstitution of immune-competence in the host improves the natural history of Hepatitis C recurrence in the liver graft, finds the most recent issue of the Journal of Hepatology.

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Hepatitis C-virus (HCV) related disease recurrence progresses rapidly after liver transplantation.

Dr Giuseppe Tisone and colleagues hypothesized that withdrawal of immunosuppression might favourably effect disease progression.

Weaning off immunosuppression was attempted in 34 Hepatitis C-RNA positive patients with a mean age of 62 years.

The patients were transplanted on average 64 months earlier, under cyclosporine A monotherapy.

The researchers followed-up the patients for 3 years including yearly protocol liver biopsies.

Primary endpoints were feasibility of weaning off immunosuppression and its impact on disease progression.

Liver function also improved in the weaned patients
Journal of Hepatology

The team's secondary endpoint was to identify predictors of an immunosuppression-free state and fibrosis progression.

Complete and permanent immunosuppression withdrawal was achieved in 23% of patients.

However, the team noted that 41% developed rejection within 8 months despite an initial response, and 35% rejected during tapering.

After a mean follow-up of 46 months, weaned patients showed stabilisation/improvement of histological fibrosis vs weaning-intolerants.

The researchers observed that lower necro-inflammation, and liver function also improved in the weaned patients compared to weaning-intolerants.

Multiple logistic regression identified low blood cyclosporine A trough levels during the first post-transplant week as a predictor of sustained weaning.

In addition, the team found that initial steroid-free immunosuppression was an independent predictor of sustained weaning.

Achievement of immunosoppression freedom, and baseline staging score were independently associated with stabilisation/improvement of histological fibrosis.

Dr Tisone's team commented, “Reconstitution of immune-competence in the host improves the natural history of Hepatitis C recurrence in the graft.”

J Hepatol 2006: 44(4): 702-9
24 March 2006

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