The Tor Vergata weaning off immunosuppression protocol in stable HCV liver transplant patients: the updated follow up at 78 months

Autor: Leonardo Baiocchi, Alberto Sanchez-Fueyo, Giuseppe Orlando, Mario Angelico, Tommaso Maria Manzia, Giuseppe Tisone
Rok vydání: 2008
Předmět:
Quality of life
Graft Rejection
medicine.medical_specialty
medicine.medical_treatment
Hepatitis C virus
Immunology
Weaning
Kaplan-Meier Estimate
allopurinol
bisphosphonic acid derivative
glucose
immunosuppressive agent
levothyroxine
lipid
neuroleptic agent
virus RNA
acute heart infarction
article
cardiovascular disease
clinical article
comparative study
controlled study
diabetes mellitus
disease course
feasibility study
follow up
glucose blood level
graft recipient
graft survival
human
human tissue
immunosuppressive treatment
liver biopsy
liver disease
liver fibrosis
liver function test
liver graft
liver graft rejection
lung carcinoma
morbidity
priority journal
quality of life
quantitative analysis
recurrent infection
virus infection
Disease Progression
Follow-Up Studies
Graft Survival
Hepatitis C
Humans
Immunosuppression
Kaplan-Meiers Estimate
Liver Transplantation
Recurrence
medicine.disease_cause
Gastroenterology
Internal medicine
medicine
Carcinoma
Immunology and Allergy
Myocardial infarction
Liver transplant
Immunosuppression Therapy
Settore MED/12 - Gastroenterologia
Transplantation
medicine.diagnostic_test
business.industry
medicine.disease
HCV recurrence
Tolerance
Settore MED/18 - Chirurgia Generale
Lipid profile
Liver function tests
business
Zdroj: Transplant immunology. 20(1-2)
ISSN: 0966-3274
Popis: Background We report the update of the Tor Vergata immunosuppression (IS) weaning protocol in stable hepatitis C virus (HCV) liver transplant (LT) recipients. Methods The weaning off IS was attempted in 34 patients who had received a LT 63.5 ± 20.1months earlier, for HCV-related end stage liver disease. Patients were observed over a period of 6.5years. During this time, yearly protocol liver biopsies were performed. Primary endpoints were determined as the feasibility of weaning off IS and its impact on the long term disease progression. Secondary endpoints were defined as the impact on patient morbidity and quality of life. Results Of the 8 originally tolerant patients, 7 remain alive and in good condition, while 1 died of severe HCV recurrence 10years post-LT and 6years after complete removal of IS. Four out of 26 intolerant individuals died of HCV recurrence (2×), lung carcinoma (1×) and acute myocardial infarction (1×), after a mean follow up period from LT of 115 (range 100–124). The 10-year survival from LT was comparable (89% vs. 87.5%). Liver graft pathology showed no significant differences between the two groups in terms of staging, fibrosis progression rate, and grading. Quantitative HCV RNA assay showed a significant non-logarithmic difference between the two groups (p = 0.03). The two groups were comparable in terms of liver function tests and lipid profile, whereas they differed with regards to glycaemia. While all tolerant individuals were euglicemic, 11 intolerant individuals developed new onset diabetes that required specific treatment (p = 0.03). Finally, significantly more intolerant patients are suffering from either cardiovascular (14/22 vs. 0/7, p = 0.01) or infectious diseases (13/22 vs. 0/7, p = 0.01). Conclusions After a 6.5-year follow up, the complete withdrawal of IS in HCV LT recipient remains safe and beneficial to patients, because it reduces the IS-related morbidity and increases the quality of life. The impact on HCV disease recurrence is less marked than after 3.5years.
Databáze: OpenAIRE
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