title: What do we know about the clinical impact of complete withdrawal of immunosuppression in liver transplantation?
abstract: The liver is a privileged organ with a lower incidence of rejection than other organs. However, immunosuppressive regimens are still required to control the alloreactive T-lymphocyte response after transplantation. These treatments may lead to severe complications, such as infectious diseases, cancers, cardiovascular diseases, and chronic renal insufficiency. In clinical transplantation, there is increasing evidence that some liver transplant recipients who cease taking immunosuppressive drugs maintain allograft function, suggesting that tolerance is already present. This strategy is feasible in 25% to 33% of liver transplant recipients. Few of the studies performed so far have provided a detailed analysis of the impact of immunosuppression (IS) withdrawal on pre-existing complications derived from the long-term administration of immunosuppressive drugs and the side effects associated with it. In preliminary studies, IS withdrawal was safely achieved in selected liver transplant patients, and improved not only kidney function, but also other IS-associated side-effects such as hypercholesterolemia, hyperuricemia, hypertension, and diabetes control. However, longer follow-up periods are needed to confirm the benefits of IS withdrawal in liver transplant patients.
authors: Division of Gastroenterology and Hepatology, Liver Transplant Unit, CIBERehd, Virgen de la Arrixaca University Hospital, Murcia, Spain. joseapons@yahoo.es
authors: J A
authors: JA
authors: Pons
authors: B
authors: B
authors: Revilla Nuin
authors: P
authors: P
authors: Ramírez
authors: A
authors: A
authors: Baroja Mazo
authors: L
authors: L
authors: Martínez Alarcón
authors: R
authors: R
authors: Robles
authors: F
authors: F
authors: Sánchez Bueno
authors: A
authors: A
authors: Rios
authors: P
authors: P
authors: Cascales Campos
authors: P
authors: P
authors: Parrilla
mesh_terms: D004334:Drug Administration Schedule; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D023001:Transplantation Tolerance / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents