TY - JOUR
T1 - A non-induction renal sparing approach after liver transplantation
T2 - High dose mycophenolate mofetil with delayed, low-dose tacrolimus
AU - Rao, V.
AU - Haywood, S.
AU - Abecassis, M.
AU - Levitsky, J.
PY - 2013/1
Y1 - 2013/1
N2 - Background: Approaches to preserve renal function after liver transplantation (OLT), such as the delayed use of calcineurin inhibitors (CNI), may reduce the need for postoperative renal replacement therapy (RRT) or simultaneous liver-kidney transplantation (SLK). Methods: An 1:1 analysis was performed comparing 1-year outcomes of patients with pre-OLT renal dysfunction receiving a renal-sparing approach (RS): MMF (3 g/d), steroids, and delayed tacrolimus (TAC) (day 3 post-OLT; trough, 5-8 ng/mL) versus SLK: MMF (2 g/d), steroids, and immediate TAC (trough 10-12 ng/mL). Results: In 84 OLT recipients (42 RS, 42 SLK) Model for End-Stage Liver Disease and creatinine were similar at OLT, with improved creatinine at 1 year (all P <.01 from OLT). Patient survival, graft function, infection, and rejection were similar at 1 year (P >.05). However, the RS patients had a higher rate of death in those requiring preoperative RRT (7/10 RRT vs 5/32 no RRT; P <.001). Of the patients on preoperative RRT, more RS patients continued to require postoperative RRT than SLK (7/10 vs 5/17; P =.04), of which there was a comparably higher death rate than those not needing postoperative RRT. Conclusion: This noninduction, RS protocol is effective in patients not on pre-OLT RRT. Patients on RRT pre-OLT should be considered for more aggressive renal sparing approaches (induction therapy with more delayed CNI initiation or SLK).
AB - Background: Approaches to preserve renal function after liver transplantation (OLT), such as the delayed use of calcineurin inhibitors (CNI), may reduce the need for postoperative renal replacement therapy (RRT) or simultaneous liver-kidney transplantation (SLK). Methods: An 1:1 analysis was performed comparing 1-year outcomes of patients with pre-OLT renal dysfunction receiving a renal-sparing approach (RS): MMF (3 g/d), steroids, and delayed tacrolimus (TAC) (day 3 post-OLT; trough, 5-8 ng/mL) versus SLK: MMF (2 g/d), steroids, and immediate TAC (trough 10-12 ng/mL). Results: In 84 OLT recipients (42 RS, 42 SLK) Model for End-Stage Liver Disease and creatinine were similar at OLT, with improved creatinine at 1 year (all P <.01 from OLT). Patient survival, graft function, infection, and rejection were similar at 1 year (P >.05). However, the RS patients had a higher rate of death in those requiring preoperative RRT (7/10 RRT vs 5/32 no RRT; P <.001). Of the patients on preoperative RRT, more RS patients continued to require postoperative RRT than SLK (7/10 vs 5/17; P =.04), of which there was a comparably higher death rate than those not needing postoperative RRT. Conclusion: This noninduction, RS protocol is effective in patients not on pre-OLT RRT. Patients on RRT pre-OLT should be considered for more aggressive renal sparing approaches (induction therapy with more delayed CNI initiation or SLK).
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U2 - 10.1016/j.transproceed.2012.06.062
DO - 10.1016/j.transproceed.2012.06.062
M3 - Article
C2 - 23267806
AN - SCOPUS:84873303978
SN - 0041-1345
VL - 45
SP - 320
EP - 322
JO - Transplantation Proceedings
JF - Transplantation Proceedings
IS - 1
ER -