Gradual Withdrawal of Immune System Suppressing Drugs in Patients Receiving a Liver Transplant (A-WISH) (ITN030ST)

The AWISH study is a multicenter, randomized Phase II trial investigating the safety and clinical outcomes of gradual immunosuppression withdrawal in adult liver transplant recipients, specifically those with hepatitis C infection and those with nonimmune, nonviral liver failure. Participants initially receive standard immunosuppressive therapy, and, after meeting strict eligibility criteria for stable graft function and absence of advanced fibrosis or recent rejection, are randomized to either a structured withdrawal protocol or continued maintenance. The study rigorously evaluates whether immunosuppression tapering can reduce long-term complications-including infection, malignancy, renal dysfunction, and HCV recurrence-without compromising graft survival, and provides critical insights into the feasibility and risks of early minimization strategies in this complex patient population.