A Pilot Study of Immunosuppressive Monotherapy in Liver Transplantation: Tacrolimus Versus Microemulsified Cyclosporin

Abstract

Tacrolimus or Neoral monotherapy after liver transplantation provides adequate immunosuppression for 87% of Tacrolimus patients and 64% of Neoral patients. In this study, 33% of patients in both groups showed no evidence of acute rejection, either clinically, biochemically or histologically, and were not exposed to steroids at any time. Evaluation of the long-term morbidity related to the side effects of the immunosuppressants given as monotherapy, for example, renal impairment and posttransplant lymphoproliferative disorder, and the effect on recurrent viral hepatitis in the graft, would be suitable areas for further study.

Applications and Limitations of Blood Eosinophilia for the Diagnosis of Acute Cellular Rejection in Liver Transplantation

“…The indication for transplantation is given in Table 1. Patients transplanted between October 1996 and January 1997 were randomized to receive immediately post-operatively either cyclosporin or tacrolimus monotherapy as part of a clinical trial (13). After January 1997, patients were immunosuppressed immediately post-operatively with prednisolone (1 mg/kg/day gradually reducing over the subsequent 2-3 weeks, then stopped) and azathioprine (1 mg/kg/day) in addition to either tacrolimus (0.1 mg/kg/day in two divided doses) or cyclosporin (10 mg/kg/day in two divided doses).…”

Early steroid withdrawal after liver transplantation: The canadian tacrolimus versus microemulsion cyclosporin a trial: 1-year follow-up

“…10,11 However, in 64 patients receiving either tacrolimus or microemulsion-CsA (micro-CsA) monotherapy, the incidence of acute rejection was high (66%) and additional immunosuppression was required in 13% and 36% of patients, respectively. 12 Tacrolimus has been associated with a lower requirement for corticosteroids, 13,14 and it has been suggested that tacrolimus may be more steroid-sparing than cyclosporin A. 15 With the goal of early steroid withdrawal, this trial was designed to determine the relative steroid-sparing potential of tacrolimus and micro-CsA after liver transplantation.…”

Protocol biopsies in liver transplantation

“…At our center, we have shown that monotherapy with calcineurin inhibitors does not result in graft loss 7,8 and has acceptable cellular rejection rates, confirmed by protocol biopsies. Changes in immunosuppression result in variations in the normalization of liver function test results compared with previous regimens.…”