THE OPTIMAL IMMUNOSUPPRESSANT AFTER LIVER-TRANSPLANTATION ACCORDING TO DIAGNOSIS - CYCLOSPORINE-A OR FK506

Since we may soon be able to choose between primarily CsA-or FK506-based immunosuppression, it is important to establish the superior immunosuppressive agent for the individual patient. In the present study, 121 patients, 61 randomly assigned to FK506- and 60 assigned to CsA-based immunosuppression, were analyzed according to the primary diagnosis for liver transplantation. One-year patient survival was similar in all groups. However, the incidence and severity of acute rejection within the Ist year after transplantation was signigicantly higher in patients transplanted due to HCV disease who were receiving FK506 (58.8%) compared with those patients receiving CsA (27.8%; p less than or equal to 0.05). Furthermore, the incidence of moderate and severe neurotoxicity was significantly higher during the 1st month after LTX in patients transplanted owing to HCV disease treated with FK506 (35.3%) compared with those patients receiving CsA (16.7%; p less than or equal to 0.05). Irrespective of the immunosuppressive regimen, the incidence of early postoperative neurotoxicity was significantly lower in patients transplanted owing to HBV disease, alcoholic cirrhosis and various other liver diseases summarized than in patients transplanted due to HCV disease receiving FK506 therapy. During the Ist year, the incidence and severity of rejection in patients transplanted due to alcoholic cirrhosis and PBC was significantly lower in patients treated with FK506 (11.1% for both groups) compared with those patients receiving CsA (54.5% and 60.0%, respectively; p less than or equal to 0.05). Furthermore, this was accompanied by a lower incidence of toxicity. Therefore, our results indicate that morbidity, according to the incidence and severity of rejection and neurotoxicity, was significantly higher in patients transplanted owing to HCV disease treated with FK506 compared with those patients receiving CsA. FK506 demonstrated superior immunosuppressive potency in patients transplanted because of alcoholic cirrhosis and PBC regarding incidence and severity of rejection, as well as incidence of neuro- and nephrotoxicity.