This work was supported by a grant from Research Projects of the Universidad de Navarra.
Trial of complete weaning from immunosuppression for liver transplant recipients: Factors predictive of tolerance
Article first published online: 26 JUL 2013
© 2013 American Association for the Study of Liver Diseases
Volume 19, Issue 9, pages 937–944, September 2013
How to Cite
de la Garza, R. G., Sarobe, P., Merino, J., Lasarte, J. J., D'Avola, D., Belsue, V., Delgado, J. A., Silva, L., Iñarrairaegui, M., Sangro, B., Sola, J. J., Pardo, F., Quiroga, J. and Herrero, J. I. (2013), Trial of complete weaning from immunosuppression for liver transplant recipients: Factors predictive of tolerance. Liver Transpl, 19: 937–944. doi: 10.1002/lt.23686
See Editorial on Page 933
- Issue published online: 28 AUG 2013
- Article first published online: 26 JUL 2013
- Accepted manuscript online: 19 JUN 2013 02:50AM EST
- Manuscript Accepted: 19 MAY 2013
- Manuscript Received: 25 FEB 2013
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 < 20), 100% reached tolerance; in the second group (n = 10 for an interval > 10 years and an SI > 20 or an interval < 10 years and an SI < 20), 60% reached tolerance; and in the third group (n = 7 for an interval < 10 years and an SI > 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.