Background: Lifelong immunosuppression (IS) after liver transplantation (LT) is associated with severe side effects and increased recipients morbidity and mortality. Achievement of clinical operational tolerance has been reported up to 40% of LT recipients. We herein report the cost savings reached for the Italian National Health System with operational tolerant recipients.
Methods: Seventy five LT recipients were previously enrolled for IS withdrawal at our institution between April 1998 and December 2015. Study population included: 32 (42%) patients tolerant that completed the withdrawal of IS therapy; 41 (54%) patients transient tolerant who underwent IS resumption after clinical or biopsy-proven sign of rejection; two (3%) patients non-tolerant who developed early rejection at the first step of drug reduction. The endpoint of this study was to assess the long-term cost saving of IS withdrawal.
Results: The IS weaning results in a cost saving for the national health Italian system of 634.000 Euros (Figure 1) for a period of 95 months (IQR= 23-109). As a matter of fact, the participation to the IS withdrawal protocol did not result in patient or graft loss during the follow up period.Conclusion: The long term IS withdrawal represents a remarkable cost saving for the national health system without exposing recipients to graft loss.