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Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Prope tolerance after pediatric liver transplantation
Christophe Bourdeaux1, Aurore Pire, Magda Janssen
1Pediatric Surgery and Transplant Unit, Saint-Luc University Clinics, Université Catholique de Louvain, Brussels, Belgium.
Pediatric Transplantation
|November 23, 2012
Summary
Pediatric liver transplant recipients on low-dose tacrolimus monotherapy (pT) achieved better graft acceptance with less immunosuppression (IS). Steroid avoidance in early immunosuppression promoted long-term tolerance, suggesting IS minimization strategies enhance graft survival.
Area of Science:
- Hepatology
- Transplantation Immunology
- Pediatric Gastroenterology
Background:
- Long-term graft acceptance after pediatric liver transplantation (LT) is crucial.
- Minimizing immunosuppression (IS) load and related toxicity is a key goal in post-LT care.
- Tacrolimus monotherapy at sub-therapeutic levels (pT) may offer a balance between efficacy and safety.
Purpose of the Study:
- To evaluate the long-term outcomes of pediatric LT recipients under different immunosuppression protocols.
- To determine if steroid avoidance influences the development of operational tolerance and graft acceptance.
- To assess the feasibility of achieving pT in pediatric LT survivors.
Main Methods:
- Retrospective review of 171 pediatric LT survivors (age <15) with >1 year post-LT follow-up.
- Analysis of immunosuppression status, focusing on tacrolimus trough levels and steroid use.
- Correlation of initial immunoprophylaxis with long-term graft acceptance and development of pT or operational tolerance.
Main Results:
- 47% of recipients achieved pT (n=73) or operational tolerance (n=6).
- Steroid-free immunosuppression was associated with a higher rate of pT/tolerance (63% vs. 41% in steroid-treated patients, p=0.012).
- 41% of patients on steroid-free regimens never experienced acute rejection or required steroids.
Conclusions:
- Steroid-free, tacrolimus-based immunosuppression may promote long-term graft acceptance and tolerance in pediatric LT.
- Minimizing immunosuppression, including steroid avoidance, appears to be a tolerogenic strategy post-pediatric LT.
- These findings provide evidence for IS minimization to enhance graft survival and reduce toxicity.
