title: Trial of complete weaning from immunosuppression for liver transplant recipients: factors predictive of tolerance.
abstract: Recipients of liver transplantation (LT) may develop immunological tolerance. Factors predictive of tolerance are not clearly understood. Transplant recipients with normal liver function tests and without active viral hepatitis or autoimmune disease who presented with side effects of immunosuppression or a high risk of de novo malignancies were selected to participate in this prospective study. Twenty-four patients fulfilled the inclusion criteria and, therefore, underwent a gradual reduction of immunosuppression. Tolerance was defined as normal liver function tests after immunosuppression withdrawal. Basal clinical and immunological characteristics, including lymphocyte counts and subpopulations (T, B, natural killer, CD4(+) , CD8(+) , and regulatory T cells) and the phytohemagglutinin stimulation index (SI), were compared for tolerant and nontolerant patients. Fifteen of the 24 patients (62.5%) were tolerant at a median of 14 months (interquartile range = 8.5-22.5 months) after complete immunosuppression withdrawal. Tolerant patients had a longer median interval between transplantation and inclusion in the study (156 for tolerant patients versus 71 months for nontolerant patients, P = 0.003) and a lower median SI (7.49 for tolerant patients versus 41.73 for nontolerant patients, P = 0.01). We identified 3 groups of patients with different probabilities of tolerance: in the first group (n = 7 for an interval > 10 years and an SI < 20), 100% reached tolerance; in the second group (n = 10 for an interval > 10 years and an SI > 20 or an interval < 10 years and an SI < 20), 60% reached tolerance; and in the third group (n = 7 for an interval < 10 years and an SI > 20), 29% reached tolerance. In conclusion, a high proportion of select LT recipients can reach tolerance over the long term. Two simple basal variables-the time from transplantation and the SI-may help to identify these patients.
authors.affiliation: Liver Unit, Clínica Universidad de Navarra, Pamplona, Spain.
authors.forename: Rocío García
authors.initials: RG
authors.lastname: de la Garza
authors.forename: Pablo
authors.initials: P
authors.lastname: Sarobe
authors.forename: Juana
authors.initials: J
authors.lastname: Merino
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Lasarte
authors.forename: Delia
authors.initials: D
authors.lastname: D'Avola
authors.forename: Virginia
authors.initials: V
authors.lastname: Belsue
authors.forename: José A
authors.initials: JA
authors.lastname: Delgado
authors.forename: Leyre
authors.initials: L
authors.lastname: Silva
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.forename: Jesus J
authors.initials: JJ
authors.lastname: Sola
authors.forename: Fernando
authors.initials: F
authors.lastname: Pardo
authors.forename: Jorge
authors.initials: J
authors.lastname: Quiroga
authors.forename: J Ignacio
authors.initials: JI
authors.lastname: Herrero
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology; D018414:CD8-Positive T-Lymphocytes / Q000166:cytology; D002469:Cell Separation; D005260:Female; D005434:Flow Cytometry; D006084:Graft Rejection / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007963:Leukocytes, Mononuclear / Q000166:cytology; D008099:Liver / Q000276:immunology; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods*; D016131:Lymphocyte Subsets / Q000166:cytology; D008297:Male; D008875:Middle Aged; D010835:Phytohemagglutinins / Q000737:chemistry; D011336:Probability; D011446:Prospective Studies; D013601:T-Lymphocytes / Q000166:cytology; D023001:Transplantation Tolerance / Q000276:immunology*
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D010835:Phytohemagglutinins