دورية أكاديمية
Immunosuppression minimization is safe and associated with good long-term success in pediatric recipients of liver transplant.
| العنوان: | Immunosuppression minimization is safe and associated with good long-term success in pediatric recipients of liver transplant. |
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| المؤلفون: | Chapin CA; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA., Whitehead B; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA., Shakhin V; Department of Pediatrics, University of Michigan Health System, University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan, USA., Taylor SA; Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA., Kriegermeier A; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA., Mohammad S; Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA., Alonso EM; Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA. |
| المصدر: | Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society [Liver Transpl] 2024 Jul 01; Vol. 30 (7), pp. 707-716. Date of Electronic Publication: 2023 Nov 08. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Wolters Kluwer Health, Inc Country of Publication: United States NLM ID: 100909185 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1527-6473 (Electronic) Linking ISSN: 15276465 NLM ISO Abbreviation: Liver Transpl Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2023- : [Philadelphia] : Wolters Kluwer Health, Inc. Original Publication: Philadelphia, PA : W.B. Saunders Co., c2000- |
| مواضيع طبية MeSH: | Liver Transplantation*/adverse effects , Liver Transplantation*/methods , Calcineurin Inhibitors*/administration & dosage , Calcineurin Inhibitors*/adverse effects , Immunosuppressive Agents*/administration & dosage , Immunosuppressive Agents*/adverse effects , Graft Rejection*/prevention & control , Graft Rejection*/immunology, Humans ; Female ; Male ; Retrospective Studies ; Child ; Child, Preschool ; Treatment Outcome ; Adolescent ; Follow-Up Studies ; Infant ; Biopsy ; Drug Administration Schedule ; Graft Survival/drug effects ; Graft Survival/immunology ; Aspartate Aminotransferases/blood ; Immunosuppression Therapy/methods ; Immunosuppression Therapy/adverse effects ; Tacrolimus/administration & dosage ; Tacrolimus/adverse effects ; Time Factors ; End Stage Liver Disease/surgery ; End Stage Liver Disease/diagnosis ; End Stage Liver Disease/immunology ; Liver/immunology ; Liver/pathology ; Liver/drug effects ; Liver/surgery |
| مستخلص: | Immunosuppression reduction after liver transplant is an important strategy to mitigate long-term medication side effects. We describe our center's experience with immunosuppression minimization to once-daily calcineurin inhibitor dosing. Success was defined as continuing daily calcineurin inhibitor monotherapy with normal transaminases and no rejection. We performed a retrospective review of eligible children who received a liver transplant between 2009 and 2016, had a surveillance biopsy, and were on twice-daily calcineurin inhibitor monotherapy. Twenty-eight of 51 eligible patients were minimized to daily calcineurin inhibitor with goal 12-hour trough detectable. Nineteen patients (68%) had 1-year success, and 17 (61%) had long-term success at a median follow-up of 5.0 years (interquartile range (IQR): 2.9-6.6). Minimization failure occurred at a median of 0.6 years (IQR: 0.3-1.0) after dose reduction. Patients with long-term success had lower aspartate aminotransferase levels prior to minimization compared to those who failed with a median of 28.0 IU/L (IQR: 20.5-32.0) versus 32.0 IU/L (IQR: 30.0-37.0), p = 0.047. The long-term success group demonstrated a trend toward greater recipients of liver transplant from living donors (53% vs. 18%, p = 0.07). At the time of the last follow-up at a median of 5.0 years (IQR: 2.9-6.1) after surveillance biopsy, most (73%) patients who failed had returned to twice-daily calcineurin inhibitor monotherapy, all had liver enzymes <2 times the upper limit of normal, and there were no patient deaths or graft losses. In conclusion, immunosuppression minimization is safe in pediatric recipients of liver transplant and should be considered to reduce long-term medication side effects and improve patient quality of life. Future studies are necessary to follow long-term outcomes and develop biomarkers to predict minimization success. (Copyright © 2023 American Association for the Study of Liver Diseases.) |
| References: | Ekong UD, Bhagat H, Alonso EM. Once daily calcineurin inhibitor monotherapy in pediatric liver transplantation. Am J Transplant. 2010;10:883–888. Feng S, Bucuvalas JC, Mazariegos GV, Magee JC, Sanchez‐Fueyo A, Spain KM, et al. Efficacy and safety of immunosuppression withdrawal in pediatric liver transplant recipients: Moving toward personalized management. Hepatology. 2021;73:1985–2004. Kim MH, Akbari O, Genyk Y, Kohli R, Emamaullee J. Immunologic benefit of maternal donors in pediatric living donor liver transplantation. Pediatr Transplant. 2019;23:e13560. Feng S, Bucuvalas J. Tolerance after liver transplantation: where are we? Liver Transpl. 2017;23:1601–14. Ng VL, Alonso EM, Bucuvalas JC, Cohen G, Limbers CA, Varni JW, et al. Health status of children alive 10 years after pediatric liver transplantation performed in the US and Canada: Report of the studies of pediatric liver transplantation experience. J Pediatr. 2012;160:820–6.e823. Soltys KA, Mazariegos GV, Squires RH, Sindhi RK, Anand R; Split Research Group. Late graft loss or death in pediatric liver transplantation: An analysis of the SPLIT database. Am J Transplant. 2007;7:2165–71. Mohammad S, Sundaram SS, Mason K, Lobritto S, Martinez M, Turmelle YP, et al. Improvements in disease-specific health-related quality of life of pediatric liver transplant recipients during immunosuppression withdrawal. Liver Transpl. 2021;27:735–46. Feng S, Bucuvalas JC, Demetris AJ, Burrell BE, Spain KM, Kanaparthi S, et al. Evidence of chronic allograft injury in liver biopsies from long-term pediatric recipients of liver transplants. Gastroenterology. 2018;155:1838–51.e1837. Vionnet J, Miquel R, Abraldes JG, Wall J, Kodela E, Lozano JJ, et al. Non-invasive alloimmune risk stratification of long-term liver transplant recipients. J Hepatol. 2021;75:1409–19. Banff Working Group on Liver Allograft Pathology. Importance of liver biopsy findings in immunosuppression management: Biopsy monitoring and working criteria for patients with operational tolerance. Liver Transpl. 2012;18:1154–70. Lin HC, Melin‐Aldana H, Mohammad S, Ekong UD, Alonso EM. Extended follow-up of pediatric liver transplantation patients receiving once daily calcineurin inhibitor. Pediatr Transplant. 2015;19:709–15. Feng S, Demetris AJ, Spain KM, Kanaparthi S, Burrell BE, Ekong UD, et al. Five‐year histological and serological follow‐up of operationally tolerant pediatric liver transplant recipients enrolled in WISP‐R. Hepatology. 2017;65:647–660. |
| المشرفين على المادة: | 0 (Calcineurin Inhibitors) 0 (Immunosuppressive Agents) EC 2.6.1.1 (Aspartate Aminotransferases) WM0HAQ4WNM (Tacrolimus) |
| تواريخ الأحداث: | Date Created: 20231107 Date Completed: 20240613 Latest Revision: 20240613 |
| رمز التحديث: | 20240614 |
| DOI: | 10.1097/LVT.0000000000000300 |
| PMID: | 37934051 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1527-6473 |
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| DOI: | 10.1097/LVT.0000000000000300 |