MAINTENANCE IMMUNOSUPPRESSION WITH CYCLOSPORINE MONOTHERAPY IN LIVER TRANSPLANT ADULT RECIPIENTS

Abstract

181 Introduction: Cyclosporine (Cy) monotherapy as maintenance immunosuppression is rarely attempted after liver transplantation (LT). We reduce immunosuppression after LT and attempt Cy monotherapy in all patients. Methods: We reviewed our long term results in a cohort of LT patients on CsA monotherapy for at least 1 or more years. All patients were induced with rabbit-ATG, Azathioprine (AZA), Prednisone (P), and Cy. AZA was withdrawn at a median of 1.6mos (range 1 week - 18mos) post LT. Prednisone was withdrawn at a median of 15.5 mos (range 2 - 37mos). The median follow-up on Cy monotherapy is 30 mos (range 7 - 58 mos). Results: Presently 51 of 59 patients (86.4%) with greater than 2yrs follow-up after LT and not on other immunosuppressive protocols are on Cy monotherapy. Three of 51 pts (6%) experienced a total of 4 rejection episodes of which three were steroid sensitive. Two of these three patients are back on daily prednisone. Three patients died, one each from recurrent hepatocellular carcinoma, hepatitis C (HCV), and reactivation of HBV. Median serum glucose and cholesterol improved on Cy monotherapy from 6.2 to 5.1 and 6.6 to 4.9 mmol/L respectively (P< 0.05). In 9 of 12 pts diabetes control improved on Cy monotherapy. Liver enzymes and bilirubin (TB) improved on Cy monotherapy and this was most pronounced in HCV positive pts (ALT from 119 to 44 IU, p < 0.01; TB from 21 to 14 mmol/L, p <0.05). Cy dose after start of Cy monotherapy has actually been reduced in most patients from a median daily dose of 275 mg/d to 175mg/d. Conclusion: Cy monotherapy is achievable and highly desirable in most LT adult recipients with minimal risk of rejection, significant improvements in serum cholesterol glucose and especially liver biochemistry most notably in HCV patients.