Minimization or withdrawal of immunosuppressants in pediatric liver transplant recipients

Background: We aimed to minimize the dose of tacrolimus in pediatric patients undergoing liver transplantation prospectively. Methods: Pediatric liver transplant recipients with stable graft function >1 year (transplant at <1 year of age), or 2 years (transplant at >1 year of age) post transplant were screened. After baseline graft biopsy, patients were enrolled into our protocol for elective tacrolimus dose reduction. Patients were assessed by liver function test and protocol biopsy during and after tacrolimus dose reduction. Results: From January 2011 to December 2012, 16 patients were recruited, of whom 15 completed follow-up at a mean 40.75 +/- 5.98 months. Six patients were preliminarily weaned off tacrolimus, and five remained tacrolimus-free for more than 2 years. Of the 10 patients who were not weaned off tacrolimus, six experienced seven episodes of clinical rejection. Five patients had a reduction in tacrolimus dosage to an undetectable trough level, another five to a trough level <4 ng/ml, including one patient who was off the study. At the last patient visit, all of the patients had normal liver function test results with no graft loss. Three patients had low-grade graft fibrosis. The patients with metabolic liver disease (p= 0.039) and who were recruited earlier after transplantation (p = 0.028) were more likely to be weaned off tacrolimus. Conclusion: Tacrolimus withdrawal is feasible in select pediatric liver transplant recipients, and long-term followup for these patients is suggested. (C) 2015 Elsevier Inc. All rights reserved.