title: Histological and biochemical effects of cyclosporine A withdrawal from a triple drug regimen after over 2 years of treatment in liver transplant patients.
abstract: Cyclosporine A was withdrawn from a triple drug immunosuppressive regimen in 10 clinically and biochemically stable liver transplant patients.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.
authors.affiliation: Department of Gastroenterology and Hepatology, University Hospital Groningen, The Netherlands.
authors.forename: I J
authors.initials: IJ
authors.lastname: Klompmaker
authors.forename: A S
authors.initials: AS
authors.lastname: Gouw
authors.forename: E B
authors.initials: EB
authors.lastname: Haagsma
authors.forename: R
authors.initials: R
authors.lastname: Verwer
authors.forename: M J
authors.initials: MJ
authors.lastname: Slooff
mesh_terms: 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*
chemical_list: D016572:Cyclosporine