The Effects of Sustained Immunosuppression Withdrawal After Liver Transplantation on Metabolic Syndrome.

IF 5.3 2区 医学 Q1 IMMUNOLOGY Transplantation Pub Date : 2024-11-01 Epub Date: 2024-05-21 DOI:10.1097/TP.0000000000005026
Roberta Angelico, Bruno Sensi, Luca Toti, Elisa Campanella, Ilaria Lenci, Leonardo Baiocchi, Giuseppe Tisone, Tommaso Maria Manzia
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Abstract

Background: Liver transplant (LT) recipients often experience adverse effects of immunosuppressive (IS) drugs, especially on metabolic profiles. Selected LT recipients can achieve successful IS withdrawal; however, its effects on metabolic syndrome (MS) are unknown.

Methods: This is a retrospective single-center study investigating the incidence and/or regression of MS in 75 selected LT recipients who were previously enrolled in prospective IS withdrawal trials between 1999 and 2017. Patients who were transplanted due to nonalcoholic steatohepatitis/metabolic-associated fatty liver disease were excluded, as well as those with a follow-up <3 y after IS weaning.

Results: Forty-four patients (58.7%) achieved sustained withdrawal or minimization of immunosuppression (WMIS) and 31 patients (41.3%) required reintroduction of immunosuppression (no-WMIS). Among LT recipients who were metabolically healthy (n = 52, 69.3%) before the start of IS weaning, there was a significantly lower rate of de novo MS in WMIS patients compared with no-WMIS patients after 5 y (8.3% and 47.8%, respectively, P  = 0.034). Of 23 LT recipients (30.7%) who had MS at the time of commencing IS withdrawal, complete regression of MS was observed in 47.1% of WMIS patients and in none (0%) of the no-WMIS patients after 5 y ( P  = 0.054). Furthermore, individual components of MS were better controlled in IS-weaned patients, such as arterial hypertension and abnormal serum lipids.

Conclusions: Achievement of sustained IS withdrawal reduces the incidence of de novo MS development in metabolically healthy patients and increases the likelihood of MS regression in patients with established MS. The foreseeable long-term beneficial effects of these favorable metabolic changes on morbidity and mortality of LT recipients require further investigation.

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肝移植后持续撤除免疫抑制对代谢综合征的影响
背景:肝移植(LT)受者经常会受到免疫抑制剂(IS)的不良影响,尤其是对代谢的影响。部分肝移植受者可以成功停用免疫抑制剂,但其对代谢综合征(MS)的影响尚不清楚:这是一项回顾性单中心研究,调查了 1999 年至 2017 年间曾参加前瞻性 IS 停药试验的 75 例精选 LT 受者的 MS 发生率和/或消退情况。因非酒精性脂肪性肝炎/代谢相关性脂肪肝而接受移植的患者以及有随访的患者被排除在外:44名患者(58.7%)实现了免疫抑制的持续撤消或最小化(WMIS),31名患者(41.3%)需要重新引入免疫抑制(无WMIS)。在开始IS断奶前代谢健康的LT受者中(n = 52,69.3%),与无WMIS患者相比,WMIS患者5年后新发多发性硬化症的比例明显较低(分别为8.3%和47.8%,P = 0.034)。在开始停用 IS 时患有 MS 的 23 名 LT 受者(30.7%)中,5 年后,WMIS 患者中有 47.1%的人观察到 MS 完全消退,而无 WMIS 患者中没有人(0%)观察到 MS 完全消退(P = 0.054)。此外,断用 IS 的患者中,MS 的个别成分得到了更好的控制,如动脉高血压和血清脂质异常:结论:持续停用 IS 可降低代谢健康患者新发多发性硬化症的发生率,并增加已确诊多发性硬化症患者多发性硬化症消退的可能性。这些有利的代谢变化对LT受者发病率和死亡率的长期有益影响尚需进一步研究。
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来源期刊
Transplantation
Transplantation 医学-免疫学
CiteScore
8.50
自引率
11.30%
发文量
1906
审稿时长
1 months
期刊介绍: The official journal of The Transplantation Society, and the International Liver Transplantation Society, Transplantation is published monthly and is the most cited and influential journal in the field, with more than 25,000 citations per year. Transplantation has been the trusted source for extensive and timely coverage of the most important advances in transplantation for over 50 years. The Editors and Editorial Board are an international group of research and clinical leaders that includes many pioneers of the field, representing a diverse range of areas of expertise. This capable editorial team provides thoughtful and thorough peer review, and delivers rapid, careful and insightful editorial evaluation of all manuscripts submitted to the journal. Transplantation is committed to rapid review and publication. The journal remains competitive with a time to first decision of fewer than 21 days. Transplantation was the first in the field to offer CME credit to its peer reviewers for reviews completed. The journal publishes original research articles in original clinical science and original basic science. Short reports bring attention to research at the forefront of the field. Other areas covered include cell therapy and islet transplantation, immunobiology and genomics, and xenotransplantation. ​
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