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Many children with liver transplants from parents can safely stop using anti-rejection drugs
Date:2/1/2012

d that 12 of them (60 percent) were able to maintain their transplanted livers for close to three years or more after discontinuing immunosuppression. (The study follow-up is continuing.) The other eight children were placed back on the medications after their livers showed signs of rejection, restoring the health of their livers.

While previous research has shown that withdrawing immunosuppression is possible in children, the current study showed the highest benefit ever achieved, Dr. Lobritto says. He adds that the study deliberately selected patients expected to have a good response, so that the investigators could determine how best to predict benefit. "This was a rigorous trial with a great deal of monitoring," he says.

All of the patients had received liver tissue donated by a parent. They were a median age of 6.9 months at transplant and about 8.5 years when they participated in the study. Most of them (16 out of 20) were transplanted because they were born with an injured bile duct that quickly led to liver failure.

"The liver is the most forgiving of organs because it has the ability to recover from injury and regenerate," says Dr. Lobritto.

Immunosuppressant drugs were tapered off over a period of 36 weeks or more, and the patients were closely monitored. During withdrawal and for three months afterward, all patients received liver function tests every two weeks and visited their physicians every three months. They then had monthly liver tests and biannual clinic visits for two years, followed by liver tests every two months and annual clinic visits. Four liver biopsies were taken.

The close monitoring resulted in the discovery of three clinical factors that predicted which patients could withdraw from their medications without repercussions: a longer time between transplant and withdrawal, absence of liver inflammation, and the absence of C4D activity in the liver.

In the next study, physicians expec
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Contact: Doug Feingold
pr@nyp.org
212-305-5587
New York- Presbyterian Hospital/Columbia University Medical Center
Source:Eurekalert

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