title: Immunosuppression withdrawal improves long-term metabolic parameters, cardiovascular risk factors and renal function in liver transplant patients.
abstract: After liver transplantation, long-term immunosuppression (IS) administration is commonly complicated by renal dysfunction and cardiovascular complications. Twenty liver transplant patients on cyclosporine (CyA)-based IS were followed up prospectively after IS withdrawal. They consisted of 10 electively weaned patients and 10 either forcibly or incidentally weaned patients. Liver biochemical tests, blood pressure, serum creatinine, serum urea, serum uric acid, triglycerides, cholesterol and glucose were monitored after the start of weaning. Eight of the 20 patients (40%) were IS therapy free for a mean period of 61 +/- 39 months (range: 10-132 months). Of the remaining 12 patients, mild or moderate acute rejection occurred in six patients (30%), and mixed inflammatory portal tract infiltrate was seen in another six patients (30%). At the end of the study, mean (SD) serum creatinine had fallen by 0.28 (0.10) mg/dL (p < 0.001) in operationally tolerant (T) patients whereas the serum creatinine level increased in IS-dependent patients [+0.35 (0.35) mg/dL] (p = 0.005). In T patients, serum cholesterol, serum uric acid, fasting glucose and diastolic arterial pressure values significantly decreased. IS withdrawal can be achieved in selected liver transplant patients, and can improve not only kidney function, but also other CyA-associated side effects, such as hypercholesterolemia, hyperuricemia, hypertension and diabetes.
authors.affiliation: Division of Gastroenterology and Hepatology, and Liver Transplant Unit, University Hospital Virgen de la Arrixaca, Murcia, Spain. joseapons@yahoo.es
authors.forename: Jose A
authors.initials: JA
authors.lastname: Pons
authors.forename: Pablo
authors.initials: P
authors.lastname: Ramírez
authors.forename: Beatriz
authors.initials: B
authors.lastname: Revilla-Nuin
authors.forename: Domingo
authors.initials: D
authors.lastname: Pascual
authors.forename: Alberto
authors.initials: A
authors.lastname: Baroja-Mazo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Robles
authors.forename: Francisco
authors.initials: F
authors.lastname: Sanchez-Bueno
authors.forename: Laura
authors.initials: L
authors.lastname: Martinez
authors.forename: Pascual
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000328:Adult; D003404:Creatinine / Q000097:blood; D016572:Cyclosporine / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D006949:Hyperlipidemias / Q000517:prevention & control; D006973:Hypertension / Q000517:prevention & control; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D007674:Kidney Diseases / Q000097:blood / Q000139:chemically induced*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D017741:Survivors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D003404:Creatinine