MINIMIZATION OF IMMUNOSUPPRESSION BEYOND FIVE YEARS FOLLOWING LIVER TRANSPLANT: LONG TERM OUTCOMES ON REJECTION, MALIGNANCY, AND MORBIDITY
Recommended Citation
Saleem A, Al-Juburi S, Faisal MS, Chaudhary A, Alomari A, Abusuliman M, Toiv A, Samad M, Haque M, Jafri S. MINIMIZATION OF IMMUNOSUPPRESSION BEYOND FIVE YEARS FOLLOWING LIVER TRANSPLANT: LONG TERM OUTCOMES ON REJECTION, MALIGNANCY, AND MORBIDITY. Hepatology 2024; 80:S1073-S1074.
Document Type
Conference Proceeding
Publication Date
10-9-2024
Publication Title
Hepatology
Abstract
Background: Post liver transplantation survival and graft preservation has substantially improved over the last few decades. Post-transplant management remains particularly challenging due to the intricate balance between immunosuppression and its adverse effects. Excess immunosuppression can be associated with metabolic disease, infection, and malignancy. Our study aims to delineate this balance to guide clinicians in their ability to safely minimize immunosuppression without predisposing to rejection. Methods: Our study included patients who have had a 10-year liver transplant course. Patients who underwent transplantation in 2013 and initiated tacrolimus were included. Patients who expired between 2018 - 2023 and those without adequate clinical data were excluded. Mean 5-year tacrolimus troughs 5 years after transplant (2018 - 2023) were calculated. A mean trough level of 4 was used as a cutoff to subcategorize our patients into those with a 5 year mean trough of ≤4 or >4. We compared the incidence of rejection, infection, malignancies, and hyperkalemia between the groups during this period. Results: 79 patients underwent liver transplants at our center in 2013. 33 expired or had inadequate data and were excluded. 44 patients met inclusion criteria, 17 Females (38%), 27 Males (61%). The mean age for our patients was 54.6 with a standard deviation of 8.9. Etiologies of cirrhosis were Hepatitis C (45.45%), Alcohol (18.18%), Nonalcoholic Steatohepatitis (18.8%), Cryptogenic (9.09%), Primary Biliary Cirrhosis (4.55%), Primary Sclerosing Cholangitis (2.27%), and Cystic Fibrosis (2.27%). 23 (52%) patients had a mean 5-year tacrolimus trough greater than 4 and 21 (48%) less than 4. 3 patients experienced rejection in the >4 group and 1 in the <4 group during this period. 2 patients in each group were hospitalized for infection. 2 patients developed a malignancy in the > 4 group and 3 in the < 4 group. No statistically significant relationship between the mean 5-year trough and incidence of rejection, hyperkalemia, and infection was found in our analysis (Table 1). Conclusion: Our findings underscore clinicians' abilities to down titrate tacrolimus levels without an associated increased risk of rejection. Conversely, higher tacrolimus levels were also not associated with an increased incidence of cancer, infections, or hyperkalemia. Our study's results may reassure providers regarding the safety of minimizing immunosuppression. This topic can benefit from larger sample sizes for increased generalizability in the future.
Volume
80
First Page
S1073
Last Page
S1074
