The Tor Vergata weaning of immunosuppression protocols in stable hepatitis C virus liver transplant patients: the 10-year follow-up

Transpl Int. 2013 Mar;26(3):259-66. doi: 10.1111/tri.12023. Epub 2012 Dec 20.

Abstract

We report herein the 10-year outcome of the Tor Vergata weaning off immunosuppression protocol in hepatitis C virus (HCV) liver transplant patients. Thirty-four patients who had received a liver graft for HCV-related cirrhosis were enrolled in a prospective study in which they were progressively weaned off immunosuppression. The primary endpoints were feasibility and safety of the weaning; the second aim was to assess fibrosis progression. At the 10-year follow-up, of the eight original tolerant patients, six remained IS-free. Of the 26 individuals who could not be weaned, 22 were alive. When the baseline biopsies were compared with the 10-year biopsies, the tolerant group showed no differences in staging, whereas the nontolerant group showed a significant increase in staging. The fibrosis progression rates calculated for the tolerant and the nontolerant groups were -0.06 ± 0.12 and 0.1 ± 0.2, respectively (P = 0.04). Furthermore, with the last taken biopsies, nine nontolerant patients were showing frank cirrhosis versus no cirrhosis among the tolerant patients. After a 10-year follow-up of a Tor Vergata weaning protocol, 6/34 patients completed follow-up without reinstitution of immunosuppression and this appeared beneficial regarding a reduction in fibrosis progression.

Publication types

  • Evaluation Study

MeSH terms

  • Age Factors
  • Aged
  • Biopsy, Needle
  • Cohort Studies
  • Disease Progression
  • Dose-Response Relationship, Drug
  • Drug Administration Schedule
  • Female
  • Follow-Up Studies
  • Graft Rejection
  • Graft Survival
  • Hepatitis C, Chronic / pathology
  • Hepatitis C, Chronic / surgery*
  • Hospitals, University
  • Humans
  • Immunohistochemistry
  • Immunosuppression / methods*
  • Immunosuppressive Agents / administration & dosage*
  • Kaplan-Meier Estimate
  • Liver Cirrhosis / pathology
  • Liver Cirrhosis / surgery*
  • Liver Cirrhosis / virology*
  • Liver Transplantation / immunology*
  • Liver Transplantation / methods
  • Liver Transplantation / mortality
  • Male
  • Middle Aged
  • Retrospective Studies
  • Risk Assessment
  • Rome
  • Sex Factors
  • Survival Analysis
  • Time Factors
  • Transplantation Immunology
  • Treatment Outcome

Substances

  • Immunosuppressive Agents