It has been reported that withdrawal of immunosuppression in cadaveric liver transplantation may be a possibility. A new study has now examined whether this may be the case in living donor liver transplant recipients.
The research, conducted by a team from the universities of Kyoto and Nagasaki, Japan, investigated 63 patients whom, between June 1990 and October 1999, were considered to be weaned from immunosuppression.
These patients consisted of 26 electively weaned patients and 37 nonelectively weaned patients. In the latter case, removal of immunosuppression was initiated either forcibly or incidentally, mainly due to infection.
Elective weaning was carried out only in patients who survived more than 2 years after transplantation, maintained a good graft function and had no rejection episodes in the preceding 12 months.
Such patients received a gradual reduction in the frequency of tacrolimus administration from the conventional twice daily dose until the start of weaning to q.d., 4 times a week, 3 times a week, twice a week, once a week, once a fortnight, once a month and finally, until patients were completely weaned. Each weaning period lasted from 3 to 6 months.
In the case of nonelective weaning, the reduction method depended on the clinical course of each individual case.
|38% of patients were completely weaned|
Reintroduction of tacrolimus, or an additional steroid bolus, was administered if patients were clinically diagnosed as developing rejection during the course of weaning.
A complete withdrawal of tacrolimus was achieved in 24 patients (38%), with a median drug-free period of 23.5 months (range, 3-69 months).
In the case of 23 patients (36.5%), weaning at various stages is still ongoing, while 16 patients (25%) encountered rejection while weaning at a median period of 9.5 months (range, 1-63 months) from the start of weaning. Additional steroid bolus therapy or tacrolimus reintroduction was successfully used to treat all 16 of these patients.
Mitsuhisa Takatsuki, a co-author of the report, said the research team had been able to achieve a "complete withdrawal of immunosuppression in some selected patients."
He added that, "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 be potential candidates to be successfully weaned from immunosuppression."