title: Minimization or withdrawal of immunosuppressants in pediatric liver transplant recipients.
abstract: BACKGROUND
  We aimed to minimize the dose of tacrolimus in pediatric patients undergoing liver transplantation prospectively.
  
  
  METHODS
  Pediatric liver transplant recipients with stable graft function >1year (transplant at <1year of age), or 2years (transplant at >1year of age) post transplant were screened. After baseline graft biopsy, patients were enrolled into our protocol for elective tacrolimus dose reduction. Patients were assessed by liver function test and protocol biopsy during and after tacrolimus dose reduction.
  
  
  RESULTS
  From January 2011 to December 2012, 16 patients were recruited, of whom 15 completed follow-up at a mean 40.75±5.98months. Six patients were preliminarily weaned off tacrolimus, and five remained tacrolimus-free for more than 2years. Of the 10 patients who were not weaned off tacrolimus, six experienced seven episodes of clinical rejection. Five patients had a reduction in tacrolimus dosage to an undetectable trough level, another five to a trough level <4ng/ml, including one patient who was off the study. At the last patient visit, all of the patients had normal liver function test results with no graft loss. Three patients had low-grade graft fibrosis. The patients with metabolic liver disease (p=0.039) and who were recruited earlier after transplantation (p=0.028) were more likely to be weaned off tacrolimus.
  
  
  CONCLUSIONS
  Tacrolimus withdrawal is feasible in select pediatric liver transplant recipients, and long-term follow-up for these patients is suggested.
authors.affiliation: Divisions of Pediatric Surgery, and Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Niang-Cheng
authors.initials: NC
authors.lastname: Lin
authors.affiliation: Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Hsin-Kai
authors.initials: HK
authors.lastname: Wang
authors.affiliation: Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Yi-Chen
authors.initials: YC
authors.lastname: Yeh
authors.affiliation: Divisions of Pediatric Surgery, and Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Chia-Pei
authors.initials: CP
authors.lastname: Liu
authors.affiliation: Divisions of Pediatric Surgery, and Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Che-Chuan
authors.initials: CC
authors.lastname: Loong
authors.affiliation: Divisions of Pediatric Surgery, and Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Hsin-Lin
authors.initials: HL
authors.lastname: Tsai
authors.affiliation: Divisions of Pediatric Surgery, and Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Cheng-Yen
authors.initials: CY
authors.lastname: Chen
authors.affiliation: Divisions of Pediatric Surgery, and Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan.
authors.forename: Taiwai
authors.initials: T
authors.lastname: Chin
authors.affiliation: Divisions of Pediatric Surgery, and Transplantation Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University, School of Medicine, Taipei, Taiwan. Electronic address: csliu@vghtpe.gov.tw.
authors.forename: Chinsu
authors.initials: C
authors.lastname: Liu
mesh_terms: D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004334:Drug Administration Schedule; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007223:Infant; D008103:Liver Cirrhosis / Q000473:pathology; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D016559:Tacrolimus / Q000008:administration & dosage*; D028761:Withholding Treatment
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus
keywords: Immunosuppressant; Liver transplantation; Operational tolerance; Pediatric; Tacrolimus; Withdrawal