Complete weaning off immunosuppression in HCV liver transplant recipients is feasible and favourably impacts on the progression of disease recurrence.

Tisone, G; Orlando, G; Cardillo, A; Palmieri, G; Manzia, Tm; Baiocchi, L; Lionetti, R; Anselmo, A; Toti, L; Angelico, M

doi:10.1016/j.jhep.2005.11.047

Tisone, G., Orlando, G., Cardillo, A., Palmieri, G., Manzia, T.m., Baiocchi, L., et al. (2006). Complete weaning off immunosuppression in HCV liver transplant recipients is feasible and favourably impacts on the progression of disease recurrence. JOURNAL OF HEPATOLOGY, 44(4), 702-709 [10.1016/j.jhep.2005.11.047].

Complete weaning off immunosuppression in HCV liver transplant recipients is feasible and favourably impacts on the progression of disease recurrence.

TISONE, GIUSEPPE;Orlando, G;Cardillo, A;PALMIERI, GIAMPIERO;MANZIA, TOMMASO MARIA;BAIOCCHI, LEONARDO;Lionetti, R;Anselmo, A;TOTI, LUCA;ANGELICO, MARIO

2006-01-01

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Scheda completa

Scheda completa (DC)

	Data di pubblicazione
	
			2006
		
	Status di pubblicazione
	
			Pubblicato
		
	DOI dell'articolo
	
			https://dx.doi.org/10.1016/j.jhep.2005.11.047
		
	Rilevanza
	
			Rilevanza internazionale
		
	Tipo
	
			Articolo
		
	Referee
	
			Sì, ma tipo non specificato
		
	Settore disciplinare dell'articolo
	
			Settore MED/18 - CHIRURGIA GENERALE
Settore MED/12 - GASTROENTEROLOGIA
		
	Lingua del contenuto
	
			English
		
	Impact Factor ISI
	
			Con Impact Factor ISI
		
	Parole chiave
	
			HCV-related disease recurrence progresses rapidly after liver transplantation. We hypothesised that withdrawal of immunosuppression might favourably impact on disease progression.

METHODS: Weaning off immunosuppression was attempted in 34 HCV-RNA positive patients (mean age 62+/-6.4 years) transplanted 63.5+/-20.1 months earlier, under cyclosporine A monotherapy. Patients were followed for 3 years including yearly protocol liver biopsies. Primary endpoints were feasibility of weaning off immunosuppression and its impact on disease progression. Secondary endpoint was to identify predictors of an immunosuppression-free state and fibrosis progression.

RESULTS: Complete and permanent immunosuppression withdrawal was achieved in 8 patients (23.4%), whereas 14 (41.2%) developed rejection within eight months despite an initial response and 12 (35.2%) rejected during tapering. After a mean follow-up 45.5+/-5.8 months weaned patients showed stabilisation/improvement of histological fibrosis (P&lt;0.01), lower necro-inflammation (P&lt;0.02) and improved liver function (P&lt;0.05) compared to weaning-intolerants. Multiple logistic regression identified low blood cyclosporine A trough levels during the first post-transplant week (P=0.004) and initial steroid-free immunosuppression (P&lt;0.008) as independent predictors of sustained weaning. Achievement of immunosoppression freedom (P=0.02) and baseline staging score (P&lt;0.0001) were independently associated with stabilisation/improvement of histological fibrosis.

CONCLUSIONS: Reconstitution of immune-competence in the host improves the natural history of HCV recurrence in the graft.
		
	Citazione
	
			Tisone, G., Orlando, G., Cardillo, A., Palmieri, G., Manzia, T.m., Baiocchi, L., et al. (2006). Complete weaning off immunosuppression in HCV liver transplant recipients is feasible and favourably impacts on the progression of disease recurrence. JOURNAL OF HEPATOLOGY, 44(4), 702-709 [10.1016/j.jhep.2005.11.047].
		
	Tutti gli autori
	
			Tisone, G; Orlando, G; Cardillo, A; Palmieri, G; Manzia, Tm; Baiocchi, L; Lionetti, R; Anselmo, A; Toti, L; Angelico, M
		
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			Articolo su rivista
		
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			01 - Articolo su rivista