Peds Liver Transplant Patients Tolerate Drug Withdrawal

For pediatric living donor liver transplant recipients, immunosuppression withdrawal possible

WEDNESDAY, Jan. 18 (HealthDay News) -- For pediatric recipients of a living donor liver transplant, immunosuppression withdrawal is feasible, with most patients able to remain off therapy for at least one year with normal graft function, according to a pilot study published in the Jan. 18 issue of the Journal of the American Medical Association.

Sandy Feng, M.D., Ph.D., from the University of California in San Francisco, and colleagues investigated the feasibility of immunosuppression withdrawal in 20 pediatric living donor liver transplant recipients. Recipients had a median age of 6.9 months at transplant and 8 years and 6 months at study enrollment. Gradual immunosuppression withdrawal was instituted over a minimum of 36 weeks, and recipients were followed for a median of 32.9 months. The primary end point was the proportion of patients who remained off immunosuppression therapy for at least one year with normal graft function.

The investigators found that, after discontinuation of immunosuppression therapy, 12 of the patients (60 percent) met the primary end point and maintained normal allograft function for a median of 35.7 months. Compared with baseline biopsies, there were no significant changes seen on biopsies obtained more than two years after withdrawal. Eight patients did not meet the primary end point because of an exclusion criteria violation (one patient), acute rejection (two patients), or indeterminate rejection (five patients). All seven patients who were treated with increased, or reinitiation of, immunosuppression therapy returned to baseline allograft function.

"In this pilot study, 60 percent of pediatric recipients of parental living donor liver transplants remained off immunosuppression therapy for at least one year with normal graft function and stable allograft histology," the authors write.

Two of the study authors disclosed financial ties to the pharmaceutical industry. One author is a co-inventor of Omnyx Digital Pathology Solution.

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