New publication of the working group of PD Dr. med. Richard Taubert

Individualized immunosuppression after liver transplantation

Long-term survival beyond the first year after liver transplantation has hardly improved in the last 30-40 years. More patients die from diseases that are favored by the long-term use of immunosuppressants than from transplant failure itself.

In order to give the patient only as much immunosuppression as necessary, but as little as possible, the Clinical Department of Gastroenterology, Hepatology and Endocrinology has been carrying out individualized immunosuppression management since 2018, which is based on so-called protocol liver biopsies, i.e. liver biopsies even with normal liver values, and the presence of antibodies directed against the transplant. These biopsies provide information about inflammation and scarring in the transplant, which to date cannot be detected accurately enough with any other non-invasive method. Based on this multi-layered information, immunosuppression - based on the individual risk of rejection (low/medium/high) - is adjusted in an interdisciplinary conference of the entire liver transplant team.

In the first clinical evaluation of this individualized immunosuppression program, our assistant physician Emily Saunders was able to show as part of her medical doctoral thesis that the protocol biopsies are safe and do not result in any relevant complications. After reducing immunosuppression, which was possible in around 30-50% of patients, there was no increased rejection rate, but kidney function was significantly spared in these patients. These results have now been accepted for publication in the high-ranking "American Journal of Transplantation" (Saunders et al. Am J Transplant. 2021 Aug 28. doi: 10.1111/ajt.16817).

This first safety assessment indicates a benefit of individualized immunosuppression for our patients, so that this program will be continued under close scientific supervision by Dr. Elmar Jäckel and PD Dr. Richard Taubert.