Prope tolerance after pediatric liver transplantation. (22nd November 2012)

• Record Type: Journal Article
• Authors: Bourdeaux, Christophe; Pire, Aurore; Janssen, Magda; Stéphenne, Xavier; Smets, Francoise; Sokal, Etienne; de, Catherine; Fusaro, Fabio; Reding, Raymond
• Is Part Of: Pediatric transplantation. Volume 17:Number 1(2013:Feb.)
• Page Start: 59
• Page End: 64
• Publication Date: 2012-11-22
• Subjects: Transplantation of organs, tissues, etc. in children -- Periodicals; 617.95408305
• DOI: 10.1111/petr.12024
• Languages: English
• ISSNs: 1397-3142

Abstract

<abstract abstract-type="main" xml:lang="en" id="petr12024-abs-0001"> <title>Abstract</title> <p>pT, under mono‐ and infratherapeutic calcineurin inhibition, may constitute an optimal condition combining graft acceptance with low IS load and minimal IS‐related toxicity. We reviewed 171 pediatric (<15.0 yr) survivors beyond one yr after LT, transplanted between April 1999 and June 2007 under tacrolimus‐based regimens (median follow‐up post‐LT: 6.0 yr, range: 0.8–9.5 yr). Their current status regarding IS therapy was analyzed and correlated with initial immunoprophylaxis. pT was defined as tacrolimus monotherapy, with mean trough blood levels <4 ng/mL during the preceding year of follow‐up, combined with normal liver function tests. The 66 children transplanted before April 2001 received a standard tacrolimus–steroid regimen. Beyond April 2001, 105 patients received steroid‐free tacrolimus–basiliximab or tacrolimus–daclizumab immunoprophylaxis. In the latter group, 43 (41%) never experienced any acute rejection episode and never received steroids. In the long term, a total of 79 recipients (47%) developed pT (n = 73) or IS‐free operational tolerance (n = 6), 27 of them belonging to the 43 steroid‐free patients (63%). In contrast, only 52/128 (41%) children treated with steroids subsequently developed prope/operational tolerance (p = 0.012). Steroid‐free tacrolimus‐based IS seems to promote long‐term graft acceptance under minimal/no IS. These results constitute the first evidence that minimization of IS, including steroid avoidance, might be tolerogenic in the long term after pediatric LT.</p> </abstract>