Histological and biochemical effects of cyclosporine A withdrawal from a triple drug regimen after over 2 years of treatment in liver transplant patients.
Cyclosporine A was withdrawn from a triple drug immunosuppressive regimen in 10 clinically and biochemically stable liver transplant patients. This study reports the effects of cyclosporine A withdrawal on liver tests and liver histology. Serum aspartate amino transferase and serum alanine amino transferase values increased significantly. Seven out of ten patients had histological changes after cyclosporine A withdrawal, but not before. These changes were compatible with acute rejection (consistent with rejection) in two patients and grade I also in two patients, including one patient with a second graft. Only two of these patients needed corticosteroid treatment (one consistent with rejection and one grade I rejection). Cyclosporine A treatment was restarted in three patients, because a coexisting osteoporosis prohibited prolonged corticosteroid recycling. Seven patients were able to maintain stable though slightly elevated transaminases without cyclosporine A, with a follow up of median 26 months. Our results suggest that in stable patients cyclosporine A withdrawal can be considered, for instance 2 years after liver transplantation.
Klompmaker
I J
IJ
Department of Gastroenterology and Hepatology, University Hospital Groningen, The Netherlands.
Gouw
A S
AS
Haagsma
E B
EB
Verwer
R
R
Slooff
M J
MJ
D000328:Adult; D016572:Cyclosporine / Q000009:adverse effects* / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008099:Liver / Q000378:metabolism* / Q000473:pathology*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D013375:Substance Withdrawal Syndrome / Q000378:metabolism* / Q000473:pathology*
D016572:Cyclosporine