Fibroscan to Guide Post Transplant Immunosuppression Minimization
Trial Parameters
Brief Summary
Following Liver transplantation, recipients remain on life long immunosuppression. Prolonged exposure to immunosuppression is associated with side effects and complications including kidney dysfunction, diabetes, heart disease and cancer risk. Therefore studies are looking at safe ways to reduce or stop immunosuppression. An individual without autoimmune liver disease (these patients are at higher risk of rejection), without history of rejection, with normal blood tests (liver biochemistry, liver function, etc.) can be eligible for minimization of immunosuppression. A recent study showed use of fibroscan (an Ultrasound, which provides information on liver stiffness (diseased liver is hard while a normal liver is soft) and fat content) provides more objective information to help investigators select individuals who will tolerate immunosuppression minimization. Our goal is to see if use of fibroscan allows the investigators to safely minimize immunosuppression in eligible individuals. The secondary aims are to assess benefit on kidney function, heart disease and risk factors for heart disease.
Eligibility Criteria
Inclusion Criteria: * 2 years or more post-liver transplant * 18 years or older Exclusion Criteria: * diagnosis of either acute or chronic rejection in the past 12 months * abnormal liver enzymes (ALT \> 50; bilirubin \> 19 umol/L) * transplant for autoimmune liver disease (autoimmune hepatitis, primary sclerosing cholangitis, and primary biliary cholangitis) * presence of HCV RNA * presence of HBV DNA * presence of class II donor specific antibodies (DSA; pre-existing or de novo) * beyond 6 years of transplantation * presence of ascites, decompensated heart failure, biliary obstruction, CKD (bl eGFR 30 ml/min/1.73m2 or less), re-transplantation, or multi-visceral transplant.