Children Can Be Weaned Of Anti-Rejection Drugs

Children who have received liver transplants can safely discontinue taking their immunosuppressant medication when clinically warranted, according to a study of 31 pediatric patients led by Jorge Reyes, M.D., associate professor of surgery, and colleagues at the University of Pittsburgh' s Thomas E. Starzl Transplantation Institute. The results, which are to be presented May 12 at the ASTP meeting, suggest some patients may not require a life-long regimen of anti-rejection medications with their accompanying side-effects.

All of the patients in the study are alive, and 25, or 81 percent, remain off immunosuppression, one for more than seven years. Six of the patients in the study were weaned as part of a controlled protocol at the UPMC involving long-term adult and child transplant recipients. The others were withdrawn from their anti-rejection drugs -- either tacrolimus or cyclosporine -- because the immunosuppressants caused acute complications, including post-transplant lymphoproliferative disorder (tumors), viral and opportunistic infections and drug toxicity. These and other complications completely resolved after withdrawal of the drugs.

Close surveillance and prompt intervention is necessary to manage rejection and avoid graft loss, says Dr. Reyes. A total of 41 adults and children have been weaned off drugs as part of the University of Pittsburgh study.

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