Subjects with infectious or autoimmune Adriamycin indications for tx, screening biopsy with more than minimal/focal inflammation or Ishak fibrosis stage>2 were excluded. ISW proceeded in 8 steps (75, 56, 40, 32, 24, 16, 8 and 0% of the pre-ISW dose) over 36-48 wks. Biopsy was mandated for ALT or GGT >100 IU/L and graded using Banff criteria by a central pathologist. BPAR was treated according to standard of care at each site. Results: As of 3/31/14,
31(42%) subjects were off IS for a median(range) of 12(0.7, 39.9) wks, 23(31%) were still undergoing ISW and 20(27%) subjects had BPAR, as described in Table 1. 15/20 BPAR episodes occurred at <33% of pre-ISW tacrolimus (TAC) dose. Using Banff criteria, a central pathologist graded 14 as mild and 5
as moderate with a median(range) rejection activity index of 4(3, 6); 1 specimen was inadequate. Treatment was with corticosteroids (16 oral; 4 IV+oral) and TAC (15 to max dose>pre-ISW; 5 to max dose ≤pre-ISW); none required antibody therapy. One subject had concurrent biliary stricture. ALT and GGT were <50IU/L in 45% of subjects by 4 wks and 90% by 16 wks after BPAR. Conclusion: Within a trial of protocolized and supervised ISW for stable, long-term pediatric liver tx recipients, BPAR most often occurred at <1/3 of the maintenance IS dose, has been histologically mild/moderate, and readily reversible with steroids and TAC. Ongoing clinical and histologic follow-up is needed to confirm that ISW is safe in the short- and long-term. *Median(range) Disclosures: John C. Magee - Grant/Research Support: Novartis, Alagille Syndrome Alliance The GSK3 inhibitor following people have nothing to disclose: Veena L. Venkat, George V. Mazariegos, John Bucuvalas, Anthony J. Demetris, Steven J. Lobritto, Mercedes Martinez, Yumirle P. Turmelle, Katharine Spain, Sandy Feng Primary sclerosing cholangitis (PSC) recurs in 15-25% of patients transplanted for PSC. Factors potentially associated with an increased risk of PSC recurrence include high MELD score, first-degree relative donors,
post-transplant CMV infection, and early biliary anastomotic complications. The aims of this study were to: 1) compare the risk of PSC recurrence in living donor (LD) versus deceased donor (DD) recipients; and 2) identify risk factors for tuclazepam PSC recurrence. METHODS: 241 LD liver transplant (LT) and 65 DDLT subjects transplanted between 1998 and 2013 enrolled in the A2ALL study were evaluated. Median follow-up was 4.9 years. PSC recurrence was defined, using the Mayo criteria, as the presence of radiographic intra-or extra-hepatic, non-anastomotic strictures or histologic fibrosing duct lesions in ABO-compatible LT recipients with a normal blood supply. PSC recurrence, graft failure, and mortality were examined using Kaplan-Meier survival curves and differences tested with the log-rank test.