Department of Pediatrics, Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea.
Yonsei Med J. 2009 Dec 31;50(6):784-8. doi: 10.3349/ymj.2009.50.6.784. Epub 2009 Dec 18.
We identified pediatric liver transplant recipients with successful withdrawal of immunosuppression who developed tolerance in Korea.
Among 105 pediatric patients who received liver transplantation and were treated with tacrolimus-based immunosuppressive regimens, we selected five (4.8%) patients who had very low tacrolimus trough levels. Four of them were noncompliant with their medication and one was weaned off of immunosuppression due to life threatening posttransplant lymphoproliferative disorder. We reviewed the medical records with regard to the relationship of the donor-recipients, patient characteristics and prognosis, including liver histology, and compared our data with previous reports.
Four patients received the liver transplantation from a parent donor and one patient from a cadaver donor. A trial of withdrawal of the immunosuppressant was started a median of 45 months after transplantation (range, 14 months to 60 months), and the period of follow up after weaning from the immunosuppressant was a median of 32 months (range, 14 months to 82 months). None of the five patients had rejection episodes after withdrawal of the immunosuppression; they maintained normal graft function for longer than 3 years (median, 38 months; range, 4 to 53 months). The histological findings of two grafts 64 and 32 months after weaning-off of the medication showed no evidence of chronic rejection.
The favorable markers for successful withdrawal of immunosuppression were 1) long-term (> 3 years) stable graft function, 2) no rejection for longer than 1 year after withdrawal of immunosuppression, 3) non-immune mediated liver diseases, and 4) pediatric patients.
我们在韩国确定了成功撤免免疫抑制剂且发生耐受的小儿肝移植受者。
在 105 例接受肝移植且接受他克莫司为基础的免疫抑制方案治疗的小儿患者中，我们选择了 5 例（4.8%）他克莫司谷浓度非常低的患者。其中 4 例患者不遵医嘱，1 例因移植后危及生命的淋巴组织增生性疾病而逐渐撤免免疫抑制剂。我们回顾了与供受者关系、患者特征和预后相关的病历资料，包括肝组织学，并与之前的报告进行了比较。
4 例患者接受了来自亲体供者的肝移植，1 例患者接受了尸体供者的肝移植。在移植后中位时间 45 个月（范围，14 个月至 60 个月）开始尝试撤免免疫抑制剂，撤免免疫抑制剂后中位随访时间 32 个月（范围，14 个月至 82 个月）。在撤免免疫抑制剂后，5 例患者均未发生排斥反应；他们的移植物功能正常持续时间超过 3 年（中位时间 38 个月；范围，4 个月至 53 个月）。停药后 64 个月和 32 个月时的 2 个移植物的组织学检查结果均未显示慢性排斥的证据。
成功撤免免疫抑制剂的有利标志物为：1）长期（>3 年）稳定的移植物功能；2）撤免免疫抑制剂后 1 年以上无排斥反应；3）非免疫介导的肝病；4）小儿患者。
