Trial of complete weaning from immunosuppression for liver transplant recipients: Factors predictive of tolerance
| Autor: | Juana Merino, Jorge Quiroga, Fernando Pardo, Juan José Lasarte, Leyre Silva, Virginia Belsue, Delia D'Avola, J. Ignacio Herrero, Bruno Sangro, Rocío García de la Garza, Mercedes Iñarrairaegui, Jesús J. Sola, Jose Antonio Delgado, Pablo Sarobe |
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| Rok vydání: | 2013 |
| Předmět: |
Autoimmune disease
Transplantation medicine.medical_specialty Hepatology business.industry Lymphocyte medicine.medical_treatment Immunosuppression Liver transplantation medicine.disease Gastroenterology medicine.anatomical_structure Interquartile range Internal medicine Immunology Medicine Surgery business Viral hepatitis Prospective cohort study |
| Zdroj: | Liver Transplantation. 19:937-944 |
| ISSN: | 1527-6465 |
| DOI: | 10.1002/lt.23686 |
| Popis: | Recipients of liver transplantation (LT) may develop immunological tolerance. Factors predictive of tolerance are not clearly understood. Transplant recipients with normal liver function tests and without active viral hepatitis or autoimmune disease who presented with side effects of immunosuppression or a high risk of de novo malignancies were selected to participate in this prospective study. Twenty-four patients fulfilled the inclusion criteria and, therefore, underwent a gradual reduction of immunosuppression. Tolerance was defined as normal liver function tests after immunosuppression withdrawal. Basal clinical and immunological characteristics, including lymphocyte counts and subpopulations (T, B, natural killer, CD4+, CD8+, and regulatory T cells) and the phytohemagglutinin stimulation index (SI), were compared for tolerant and nontolerant patients. Fifteen of the 24 patients (62.5%) were tolerant at a median of 14 months (interquartile range = 8.5-22.5 months) after complete immunosuppression withdrawal. Tolerant patients had a longer median interval between transplantation and inclusion in the study (156 for tolerant patients versus 71 months for nontolerant patients, P = 0.003) and a lower median SI (7.49 for tolerant patients versus 41.73 for nontolerant patients, P = 0.01). We identified 3 groups of patients with different probabilities of tolerance: in the first group (n = 7 for an interval > 10 years and an SI 10 years and an SI > 20 or an interval 20), 29% reached tolerance. In conclusion, a high proportion of select LT recipients can reach tolerance over the long term. Two simple basal variables—the time from transplantation and the SI—may help to identify these patients. Liver Transpl 19:937–944, 2013. © 2013 AASLD. |
| Databáze: | OpenAIRE |
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