Long-term follow-up of 23 operational tolerant liver transplant recipients

Panagiotis Tryphonopoulos, Phillip Ruiz, Debbie Weppler, Seigo Nishida, David M. Levi, Jang Moon, Akin Tekin, Madeline Velez, Danielle Rachel Neuman, Eddie Island, Gennaro Selvaggi, Andreas G. Tzakis

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


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withdrawal study that we previously performed on 104 liver transplant patients in which immunosuppression was gradually withdrawn over a period of 3 years. Eighty-one patients were not able to be withdrawn (rejectors), and 23 patients were successfully weaned off immunosuppression (tolerants).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.

Original languageEnglish (US)
Pages (from-to)1556-1561
Number of pages6
Issue number12
StatePublished - Dec 27 2010


  • Immunosuppression withdrawal
  • Liver transplantation
  • Tolerance

ASJC Scopus subject areas

  • Transplantation


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