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A randomised controlled trial of total immunosuppression withdrawal in stable liver transplant recipients
  1. N Assy,
  2. P C Adams,
  3. P Myers,
  4. V Simon,
  5. C N Ghent
  1. Liver Unit, Sieff Hospital, Safed, Technion Institute, Israel, and Multi Organ Transplant Unit and Department of Medicine, London Health Science Centre, London, Ontario, Canada
  1. Correspondence to:
    Dr N Assy
    Head Liver Unit, Sieff Hospital, Safed, 13100, Upper Galilee, Israel; assy.n{at}ziv.health.gov.il

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Total withdrawal of immunosuppression (TIW) without causing rejection has been reported in some stable liver recipients.1–3 Patient characteristics which predict this clinical tolerance have not been determined. Ursodeoxycholic acid (UDCA) has been reported to reduce the risk of early graft rejection following hepatic and cardiac transplantation.4 We conducted a double blind controlled trial of UDCA therapy followed by TIW in 26 liver recipients to (a) determine if UDCA would facilitate TIW, (b) assess the safety of attempting TIW and (c) determine predictors of success of TIW.

Patients and methods

Records were reviewed and all patients who had been free of rejection for a minimum of 2 years, and on single or double drug immunosuppression, with transaminase levels <1.5 times the upper limit of normal, were invited to participate. Twenty six (13 male) patients gave informed consent and entered the study. Baseline …

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