title: Stepwise minimization of the immunosuppressive therapy in pediatric liver transplantation. A conceptual approach towards operational tolerance.
abstract: The evolution of immunosuppression in pediatric liver transplantation has been characterized by a steady reduction of the immunosuppressive load, including removal of anti-lymphocyte antibodies, with the aim to reduce the incidence of EBV-related post-transplant lymphoproliferative disorders. Acute rejection rates were studied retrospectively over two decades of pediatric liver transplantation, according to the successive immunoprophylactic regimens. 318 primary pediatric liver transplant recipients, included between 1984 and 2004 in successive prospective trials, were analyzed, with respect to the impact of the immunosuppressive protocol on acute rejection occurrence. A progressive decrease of rejection incidences was observed, which corresponded to reduced immunosuppressive load and to transplant eras. Such trend might be related to changing approaches towards acute rejection histology and therapy by transplant clinicians, but also to the stepwise minimization of immunosuppressive protocols, putatively enhancing graft acceptance. We hypothesize that the recent population of liver transplant recipients with low immunosuppression might be more suitable for progressive immunosuppression withdrawal trial, with the aim to reach ultimately operational tolerance.
authors.affiliation: Pediatric Liver Transplant Program, Saint-Luc University Clinics, Université catholique de Louvain, Brussels, Belgium. reding@chex.ucl.ac.be
authors.forename: Raymond
authors.initials: R
authors.lastname: Reding
authors.forename: Jérémie
authors.initials: J
authors.lastname: Gras
authors.forename: Christophe
authors.initials: C
authors.lastname: Bourdeaux
authors.forename: Grégoire
authors.initials: G
authors.lastname: Wieers
authors.forename: Quang Dinh
authors.initials: QD
authors.lastname: Truong
authors.forename: Dominique
authors.initials: D
authors.lastname: Latinne
authors.forename: Etienne
authors.initials: E
authors.lastname: Sokal
authors.forename: Magda
authors.initials: M
authors.lastname: Janssen
authors.forename: Jan
authors.initials: J
authors.lastname: Lerut
authors.forename: Jean-Bernard
authors.initials: JB
authors.lastname: Otte
authors.forename: Jean
authors.initials: J
authors.lastname: de Ville de Goyet
mesh_terms: D000293:Adolescent; D000961:Antilymphocyte Serum / Q000187:drug effects / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D006084:Graft Rejection / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007223:Infant; D016031:Liver Transplantation / Q000276:immunology*; D008232:Lymphoproliferative Disorders / Q000209:etiology / Q000276:immunology / Q000517:prevention & control*; D015337:Multicenter Studies as Topic; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D013601:T-Lymphocytes / Q000276:immunology; D016559:Tacrolimus / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016559:Tacrolimus