title: Long-term follow-up of 23 operational tolerant liver transplant recipients.
abstract: BACKGROUND
  This is a follow-up of a withdrawal study that we previously performed on 104 liver transplant patients in which immunosuppression was gradually withdrawn over a period of 3 years. Eighty-one patients were not able to be withdrawn (rejectors), and 23 patients were successfully weaned off immunosuppression (tolerants).
  
  
  METHODS
  In this study, we present their follow-up after the end of the withdrawal study: we compared the results of the tolerant patients (n=23) with those of the rejectors (n=81). Follow-up was until February 2010.
  
  
  RESULTS
  Operational tolerant patients were off immunosuppression for an average of 7.27±0.28 years. Patient survival in the tolerant and the rejector groups was 63.66% and 74.25%, respectively (P=not significant). A patient in the rejector group received two retransplants for chronic rejection. In the rejector group, 19 patients presented 26 rejection episodes: clinically suspected (n=19) and biopsy-proven mild (n=4), moderate (n=2), and severe (n=1) rejection episodes. A tolerant patient had a moderate rejection episode of 5.3 years after immunosuppression withdrawal. In the rejector group, five patients received a kidney transplant and four more are on dialysis versus a tolerant patient on dialysis. Freedom from rejection in the tolerant and rejector groups was 95% and 73%, respectively (P<0.05), and freedom from renal replacement treatment was 83.33% vs. 44.58%, respectively (P=not significant).
  
  
  CONCLUSIONS
  Long-term outcomes of operationally tolerant liver transplant patients are at least as good as those of control patients. Operational tolerance is not a permanent state, and continuous vigilance is required to detect rejection episodes.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Miami School of Medicine, Highland Professional Building, Miami, FL, USA.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tryphonopoulos
authors.forename: Phillip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Debbie
authors.initials: D
authors.lastname: Weppler
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: David M
authors.initials: DM
authors.lastname: Levi
authors.forename: Jang
authors.initials: J
authors.lastname: Moon
authors.forename: Akin
authors.initials: A
authors.lastname: Tekin
authors.forename: Madeline
authors.initials: M
authors.lastname: Velez
authors.forename: Danielle Rachel
authors.initials: DR
authors.lastname: Neuman
authors.forename: Eddie
authors.initials: E
authors.lastname: Island
authors.forename: Gennaro
authors.initials: G
authors.lastname: Selvaggi
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: D004334:Drug Administration Schedule; D004361:Drug Tolerance; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000453:epidemiology / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology* / Q000502:physiology; D013375:Substance Withdrawal Syndrome; D013997:Time Factors; D023001:Transplantation Tolerance / Q000276:immunology*
chemical_list: D007166:Immunosuppressive Agents