Background

The liver transplant recipients are often subjected to excessive therapy by immunosuppressive drugs which produce several complications. Consequently, the minimization or even withdrawal of immunosuppression in selected patients is an attractive alternative. We investigated the frequency and characteristics of these near (or prope from Latin) tolerance in liver transplant recipients in Shiraz Organ Transplant Center.

Material and methods

We reviewed the medical records of over 3800 adult liver transplant recipients to select a group treated with a low-dose tacrolimus monotherapy (n = 90) between 1994 and 2017 in our transplant center. The patients with the best liver function parameters were selected; then, the clinician arbitrarily decided to withdraw steroids first and then mycophenolate mofetil and maintain each patient on a low dose tacrolimus.

We compared the characteristics of prope tolerant recipients on a low-dose tacrolimus with those on standard immunosuppression, namely full-dose tacrolimus plus steroids and mycophenolate mofetil (n = 233). Data were analyzed by t-test, chi-square test using SPSS software version 16.

Results

Out of over 3800 liver transplant patients, 90 (2.34%) recipients were treated with a minimum dose of tacrolimus monotherapy. These recipients were compared to a selected group of 233 (6.1%) recipients treated with full-dose tacrolimus plus steroids and mycophenolate mofetil. In a prope tolerant group, there were 55 males (61.1%) and 35 females (38.9%) recipients. Mean age at the time of transplant was 39.92 ± (SD = 13.40) years with an average time from the transplantation time to completed weaning from triple immunosuppression to low-dose monotherapy of 41.35 months (SD = 17.27). The most common etiology of liver disease among both groups was viral hepatitis.

Conclusion

The achievement of prope (almost) immune tolerance was possible only in some liver transplant recipients with a relatively low risk of rejection. Our analysis suggests that there is a difference in the underlying diseases and recipients' age between the two groups.

中文翻译：

---

Prope（几乎）耐受和完全免疫抑制方案成人肝移植受者的特征比较

背景

肝移植受者经常受到免疫抑制药物的过度治疗，这会产生多种并发症。因此，在选定的患者中最小化甚至停止免疫抑制是一种有吸引力的选择。我们在设拉子器官移植中心调查了肝移植受者中这些接近（或来自拉丁语）耐受性的频率和特征。

材料与方法

我们回顾了 3800 多名成年肝移植受者的医疗记录，以选择 1994 年至 2017 年间在我们的移植中心接受低剂量他克莫司单药治疗的一组 ( n  = 90)。选择肝功能参数最佳的患者；然后，临床医生武断地决定先停用类固醇，然后停用吗替麦考酚酯，并维持每位患者服用低剂量他克莫司。

我们比较了低剂量他克莫司与标准免疫抑制（即全剂量他克莫司加类固醇和霉酚酸酯）的耐受性受体的特征（n  = 233）。使用 SPSS 软件 16 版通过t检验、卡方检验分析数据。

结果

在 3800 多名肝移植患者中，90 名 (2.34%) 接受者接受了最小剂量的他克莫司单药治疗。将这些受者与接受全剂量他克莫司加类固醇和霉酚酸酯治疗的 233 名 (6.1%) 受者进行比较。在生殖耐受组中，有 55 名男性 (61.1%) 和 35 名女性 (38.9%) 接受者。移植时的平均年龄为 39.92 ±（SD = 13.40）岁，从移植时间到完成从三联免疫抑制到低剂量单药治疗的平均时间为 41.35 个月（SD = 17.27）。两组中最常见的肝病病因是病毒性肝炎。

结论

只有在一些排斥风险相对较低的肝移植受者中才能实现（几乎）免疫耐受。我们的分析表明，两组之间的基础疾病和接受者年龄存在差异。