Improvements in Disease‐Specific Health‐Related Quality of Life of Pediatric Liver Transplant Recipients During Immunosuppression Withdrawal

Abstract

Long-term immunosuppression (IS) leads to systemic complications affecting health-related quality of life (HRQOL) in pediatric liver transplantation (LT) recipients. We serially assessed HRQOL using the PedsQL Generic and Multidimensional Fatigue Scales and Family Impact and Transplant Modules as part of a multicenter prospective immunosuppression withdrawal (ISW) trial between 2012 and 2018. Participants received a primary LT ≥4 years before the study and were on stable IS with normal liver tests and without rejection in the prior 2 years. IS was withdrawn in 7 steps over 36 to 48 weeks. HRQOL was assessed at regular intervals. The primary endpoint was change in disease-specific HRQOL measured by the PedsQL Transplant Module. Generic HRQOL was measured by the PedsQL Generic Scale and was compared with an age-matched and sex-matched multicenter cohort. Of the 88 participants, 39 were boys, median age was 11 years (range, 8-13), and time since transplant was 9 years (range, 6-11). For 36 months, disease-specific HRQOL improved for all participants, whereas generic HRQOL was unchanged. Neither generic nor disease-specific HRQOL changed for the 35 participants who developed acute rejection during ISW. In the first use of patient-reported outcome measures during an ISW trial, we found improvements in disease-specific HRQOL in all participants and no lasting detrimental effects in those who experienced rejection.

Immunosuppression minimization is safe and associated with good long-term success in pediatric recipients of liver transplant

“…[5,6] Furthermore, a decrease in IS is a priority for patients and families and has been associated with an improvement in transplantspecific health-related quality of life over time. [7] Our results underscore the importance of performing a surveillance liver biopsy prior to considering IS minimization and continuing to follow these patients with surveillance biopsies over time. We continue to recommend repeat surveillance biopsies every 5 years for all patients to monitor the health of the graft and identify subclinical inflammation or injury.…”

Time since liver transplant and immunosuppression withdrawal outcomes: Systematic review and individual patient data meta‐analysis

“…4,[8][9][10][11]13,14, An update search returned 318 unique reports, of which three were screened in full text and only one was included. 12 Two iterations of backward and forward citation searching on included records yielded further 1188 records, of which nine were screened in full text and four [43][44][45][46] were included. Owing to cohort overlap or multiple reports on the same study (Table S2), the 35 included reports were found to cover 17 independent studies with extractable pre-withdrawal time data for meta-analysis (Table 1).…”

Operational Tolerance after Liver Transplantation: First Report from India

“…Thus, minimization and if possible, even withdrawal of these medications is currently the guiding principle of designing individualized immunosuppression protocols worldwide. If achieved, this immunosuppression-free state has been proven to reduce the metabolic syndrome risks and other attendant side effects and also improve overall quality of life [5,7,8].…”