Title: Immunosuppression minimization is safe and associated with good long-term success in pediatric liver transplant recipients
Source: Liver Transplantation 2023, Nov 8. [E-publication]
Date of publication: November 2023
Publication type: Article
Abstract: 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 2009-2016, had a surveillance biopsy, and were on twice daily calcineurin inhibitor monotherapy. Twenty eight of 51 eligible patients were minimized with calcineurin inhibitor goal 12-hour trough detectable. Nineteen patients (68%) had 1-year success, and 17 (61%) had long-term success at 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 median 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 living donor recipients (53% vs. 18%, p=0.07). At time of last follow up at median 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 less than 2-times upper limit of normal, and there were no patient deaths or graft losses. In conclusion, immunosuppression minimization is safe in pediatric liver transplant recipients 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.