Long-Term Follow-Up of 23 Operational Tolerant Liver Transplant Recipients

Introduction. This is a follow-up of a withdrawal study that we previously performed on 104 liver transplant patients in which immunosuppression was gradually withdrawn over a period of 3 years. Eighty-one patients were not able to be withdrawn (rejectors), and 23 patients were successfully weaned off immunosuppression (tolerants). Methods. In this study, we present their follow-up after the end of the withdrawal study: we compared the results of the tolerant patients (n = 23) with those of the rejectors (n = 81). Follow-up was until February 2010. Results. Operational tolerant patients were off immunosuppression for an average of 7.27 +/- 0.28 years. Patient survival in the tolerant and the rejector groups was 63.66% and 74.25%, respectively (P = not significant). A patient in the rejector group received two retransplants for chronic rejection. In the rejector group, 19 patients presented 26 rejection episodes: clinically suspected (n = 19) and biopsy-proven mild (n = 4), moderate (n = 2), and severe (n = 1) rejection episodes. A tolerant patient had a moderate rejection episode of 5.3 years after immunosuppression withdrawal. In the rejector group, five patients received a kidney transplant and four more are on dialysis versus a tolerant patient on dialysis. Freedom from rejection in the tolerant and rejector groups was 95% and 73%, respectively (P<0.05), and freedom from renal replacement treatment was 83.33% vs. 44.58%, respectively (P = not significant). Conclusions. Long-term outcomes of operationally tolerant liver transplant patients are at least as good as those of control patients. Operational tolerance is not a permanent state, and continuous vigilance is required to detect rejection episodes.