Portal de investigación
Complete immunosuppression withdrawal after liver transplantation: An International Multicenter Study.
Autores de IIS La Fe
Participantes ajenos a IIS La Fe
- Angelico R
- Sensi B
- Tisone G
- Feng S
- Roll GR
- Herrero I
- Bonaccorsi-Riani E
- Pons JA
- Ruíz P
- Den Hoed C
- Mazariegos G
- Smith R
- Parente A
- Aluvihare V
- Sanchez-Fueyo A
- Tan E
- Calretas S
- Lanari J
- Spada M
- Montano-Loza AJ
- De Meijer VE
- Pirenne J
- Riley C
- Chahal D
- De Martin E
- Di Sandro S
- Patrono D
- García-Juárez I
- Cachero A
- Adali G
- Ghinolfi D
- Camagni S
- Milla AA
- Bayramov N
- Elbahr O
- Manzia TM
- Rogers R
- Mehdi T
- Jakoubek D
- Pascual M
- Iñarrairaegui M
- Foguenne M
- Ciccarelli O
- Mazo AB
- Romero PR
- Colmenero J
- Polak W
- Lytvyak E
- Glassey E
- Rajoriya N
- Muthiah M
- Boccagni P
- Blokzijl H
- Rodriguez-Perálvarez M
Grupos
Abstract
BACKGROUND & AIMS: Immunosuppression withdrawal (ISW) after liver transplantation (LT) is feasible in selected individuals but the risk of chronic graft damage is unknown. We aimed to describe the clinical characteristics and long-term outcomes of patients with successful ISW after LT. METHODS: Retrospective cohort study involving 31 LT centres in 15 countries. Adult and paediatric patients with complete ISW for =12 months following LT were eligible. We evaluated long-term outcomes, including evidence of histological graft injury, rejection, and mortality. RESULTS: In all, 287 patients (223 adults and 64 children) were included, representing 0.46% of the reference LT population. The median time from LT to ISW was 9.4 years, followed by 7.8 years of post-withdrawal follow-up. The most common reasons for ISW were participation in a clinical trial (53%), patient decision (25.1%), and immunosuppression-related side effects (16.7%). ISW was associated with metabolic improvement including reductions in diabetes (34.1% to 19.7%) and hypertension (58.7% to 31.4%). Paired liver biopsies before and after ISW were available in 108 patients (37.6%) and among them 43.5% achieved operational tolerance. Worsening fibrosis (=1 Ishak's stage) and new-onset inflammation occurred in 30.5% and 22.2% of patients, respectively. Five-year overall survival after ISW was 93%, and no patient experienced immunologically mediated graft loss. Neither worsening fibrosis nor inflammation had an impact on mortality (HR=1.77 [95%CI 0.63-4.96] and HR=1.46 [95%CI 0.39-5.49], respectively). CONCLUSIONS: ISW after LT may improve metabolic comorbidities. Mild histological graft changes may occur, but do not appear to affect long-term outcomes. Future studies should focus on safely expand ISW to a broader subset of LT patients.
Copyright © 2026 The Author(s). Published by Elsevier Inc. All rights reserved.
Datos de la publicación
- ISSN/ISSNe:
- 1542-3565, 1542-7714
- Tipo:
- Article
- Páginas:
- -
- PubMed:
- 42263796
Clinical Gastroenterology and Hepatology ELSEVIER SCIENCE INC
Documentos
- No hay documentos
Filiaciones
Keywords
- calcineurin inhibitors; liver biopsy; tacrolimus; tolerance; weaning
Cita
Angelico R,Sensi B,Tisone G,Feng S,Roll GR,Herrero I,Bonaccorsi E,Pons JA,Ruíz P,BERENGUER M,Den C,Mazariegos G,Smith R,Parente A,Aluvihare V,Sanchez A,Tan E,Calretas S,Lanari J,Spada M,Montano AJ,De Meijer VE,Pirenne J,Riley C,Chahal D,De Martin E,Di S,Patrono D,García I,Cachero A,Adali G,Ghinolfi D,Camagni S,Milla AA,Bayramov N,Elbahr O,Manzia TM,Rogers R,Mehdi T,Jakoubek D,Pascual M,Iñarrairaegui M,Foguenne M,Ciccarelli O,Mazo AB,Romero PR,Colmenero J,AGUILERA MV,Polak W,Lytvyak E,Glassey E,Rajoriya N,Muthiah M,Boccagni P,Blokzijl H,Rodriguez M. Complete immunosuppression withdrawal after liver transplantation: An International Multicenter Study. Clin. Gastroenterol. Hepatol.