BACKGROUND: @entity1140 is a potent immunosuppressive agent that provides higher freedom from acute and chronic rejection than @entity205 after liver transplantation (LTx). Initially, a @entity134 -free state was observed in about 70% of @entity1 at 1 year; this did not change over the next 5 years. The present study identifies the various reasons why the remaining 30% of adult @entity1 still require @entity230 even after 5 years after successful LTx. METHOD: Eight hundred thirty-four consecutive @entity1 who underwent LTx between August 1989 and December 1992 were included in this study. Four hundred ninety-nine @entity1 were alive in January 1999 and were available for this study. The dose of @entity134 and the reason for @entity134 use were retrospectively determined from the clinical records. RESULTS: Three hundred sixty-five @entity1 (73.1%) were off @entity134 , whereas 134 @entity1 (26.9%) were receiving @entity229 (mean dose was 6.4+/-3.7 mg/day) at the time of the study. Four hundred and eight-four @entity1 (97%) were off @entity229 at some time after LTx; however, in 119 (23.8%) @entity1 , @entity230 were reintroduced. Fifteen @entity1 (3%) continued to receive @entity229 ; eight receive @entity229 due to reluctance of the local physician to withdraw the medication; in five @entity1 , the @entity229 was not withdrawn because these @entity1 were on @entity205 ; in the remaining two @entity1 , repeated attempts to withdraw @entity134 resulted in a rise in liver function test. In the 49 (36.6%) of 119 @entity1 in whom the @entity134 was reintroduced, it was restarted secondary to pathologically proven or clinically suspected rejection (group I). In five @entity1 @entity134 was reintroduced for @entity409 after being off immunosuppression for treatment of a @entity1071 . Six @entity1 were noncompliant with their immunosuppressive medication, and the @entity134 was reintroduced to control rejection. @entity230 were reintroduced in 30 @entity1 (22.4%) for recurrence of original disease: @entity2835 (n= 19), sclerosing @entity255 (n=6), and @entity775 (n=5) (group II). In 24 @entity1 (20.2%), @entity230 were reintroduced to lower the dose of @entity1140 secondary to nephrotoxicity. Six of these @entity1 received kidney transplantation (group III). In 16 @entity1 (13.4%) the @entity134 was reintroduced for concomitant medical problems, consisting of @entity31 (n=6), @entity1887 (n=5), @entity1503 (n=3), @entity1909 (n=1), and @entity309 (n=1) (group IV). CONCLUSION: Ninety-seven percent of @entity1 under @entity1140 were weaned off @entity134 ; however, 23.8% required @entity134 reintroduction for late rejection, recurrence of @entity792 (es), @entity8 , or the concomitant presence of other medical conditions. Although the use of other immunosuppressive agents may reduce the rate of reintroduction of @entity134 , long-term sustained freedom from @entity134 may not be possible in all @entity1 under @entity1140 secondary to these conditions.

Reasons for long-term use of @entity134 in primary adult liver transplantation under XXXX .

@entity1 :: ('9606', 'Species') :: ['patients'] @entity2835 :: ('MESH:D008105', 'Disease') :: ['primary biliary cirrhosis'] @entity8 :: ('MESH:D007674', 'Disease') :: ['renal impairment'] @entity1071 :: ('MESH:D008232', 'Disease') :: ['posttransplantation lymphoproliferative disorder'] @entity309 :: ('MESH:D001172', 'Disease') :: ['rheumatoid arthritis'] @entity229 :: ('MESH:D011241', 'Chemical') :: ['prednisone'] @entity1887 :: ('MESH:D000309', 'Disease') :: ['adrenal insufficiency'] @entity409 :: ('MESH:D008107', 'Disease') :: ['abnormal liver function'] @entity31 :: ('MESH:D003093', 'Disease') :: ["ulcerative/Crohn's colitis"] @entity1503 :: ('MESH:D006402', 'Disease') :: ['hematological disorders'] @entity134 :: ('CHEBI:35341', 'Chemical') :: ['steroid'] @entity205 :: ('MESH:D016572', 'Chemical') :: ['cyclosporine'] @entity792 :: ('MESH:D001327', 'Disease') :: ['autoimmune process'] @entity1140 :: ('MESH:D016559', 'Chemical') :: ['Tacrolimus', 'tacrolimus'] @entity230 :: ('MESH:D013256', 'Chemical') :: ['Steroids', 'steroids'] @entity1909 :: ('MESH:D003872', 'Disease') :: ['dermatitis'] @entity255 :: ('MESH:D002761', 'Disease') :: ['cholangitis'] @entity775 :: ('MESH:D019693', 'Disease') :: ['autoimmune hepatitis']
@entity1140 :: (MESH:D016559,Chemical) :: ['tacrolimus']
