A prospective randomized trial comparing tacrolimus and steroids with tacrolimus monotherapy in liver transplantation: the impact on recurrence of hepatitis C

Margarit, C; Bilbao, Itxarone; Castells, Lluı́s; López, Iñigo; Pou, Leonor; Allende, E; Escartín, Alfredo

doi:10.1111/j.1432-2277.2005.00217.x

Cited by 55 publications

(70 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…During 3 years after transplantation, significantly less hepatic cirrhosis occurred among patients who received no cortin REVIEWS n n 239 n costeroids in addition to tacrolimus as compared to those who took corticosteroids (9% vs. 45%, p = 0.04). Survival rates at 1, 3 and 5 years in patents taking tacrolimus or tacrolimus and a steroid together were 92%, 92%, 73% and 78%, 61%, 51% respectively [22]. Data in Hungary also confirm that acute rejection and subsequent bolus steroid therapy favours early HCV recurrence [2].…”

Section: Effect Of Immunosuppressive Therapy On Recurrent Hcv Infectionsupporting

confidence: 58%

Treatment of recurrent hepatitis C virus infection in patients after liver transplantation

Lengyel¹,

Tulassay²

2009

Clinical and Experimental Medical Journal

View full text Add to dashboard Cite

The main indication for liver transplantation is the final stage of hepatic cirrhosis developed due to hepatitis C virus (HCV) infection. The recurrence of HCV infection after transplantation is a common situation. Recurrent hepatitis C is a progressive disease; in 20% of patients it produces liver cirrhosis without treatment beside immunosuppression within 5 years. Treatment of recurrent HCV infection is the most important factor of survival in patients with transplantation. Based on literary data and their observations, the authors review the factors influencing the progression of recurrent HCV infection. They discuss in details the effect of immunosuppressive therapy, the importance of selecting appropriate immunosuppressive drugs. They review the key points in the diagnosis of recurrent hepatitis C; underline the decisive role of liver biopsy carried out according to protocol in the diagnosis, as well as the hard consultation between specialists of pathology, hepatology and surgery. They demonstrate their observations with the treatment of patients on the waiting list, the results of early pre-emptive treatment of recurrent chronic hepatitis, furthermore treatment modalities and results in patients with histologically proven chronic hepatitis C. The drug of choice for chronic hepatitis C after transplantation is combined therapy with pegylated interferon and ribavirin. This therapy is able to assure sustained virological negativity in 20-50% of patients. In virus-free patients the inflammatory activity in the liver significantly decreases, and the histologic activity index improves. There are data showing a fibrosis-inhibiting effect of the treatment, however, multicentric studies are required for their confirmation. No advantage of early antiviral treatment without histologic alteration has been confirmed by most of the trials. In this group of patients common side effects of the treatment include anaemia and neutropenia, and therefore administration of erythropoietin and granulocyte stimulating factor is recommended. Further research and clinical studies are required in order to establish optimal treatment of patients with recurrent hepatitis C, to determine the dosage of pegylated interferon and ribavirin, to decrease duration of therapy, to reduce side effects and finally to achieve the healing phase in a greater percentage of patients.

show abstract

Section: Effect Of Immunosuppressive Therapy On Recurrent Hcv Infectionsupporting

confidence: 58%

Treatment of recurrent hepatitis C virus infection in patients after liver transplantation

Lengyel¹,

Tulassay²

2009

Clinical and Experimental Medical Journal

View full text Add to dashboard Cite

show abstract

“…Tacrolimus was compared to cyclosporine in one trial (Mayer et al, 1997), microemulsified cyclosporine in four trials (Margreiter et al, 2002;Murphy et al, 2003;O'grady et al, 2002;The US Multicenter FK 506 Liver Study Group, 1994) and two trials compared tacrolimus to steroids (Margarit et al, 2005;Moench et al, 2007). The compared drug would be referred as "control" in this analysis.…”

Section: Description Of Studies Includedmentioning

confidence: 99%

“…Four studies measured neurotoxic effects of tacrolimus (Margreiter et al, 2002;The US Multicenter FK 506 Liver Study Group, 1994;Margarit et al, 2005;Moenche et al, 2007); tacrolimus-treated patients had high odds of having neurotoxicity such as tremor and headache. The Cochran Q-test showed p-value of 0.11 and the I among the studies.…”

Section: Adverse Effects: Post-transplant Diabetes Mellitus Hypertenmentioning

confidence: 99%

“…Mean age (± SD) Diagnosis Tacrolimus dosage Tacrolimus level (<3 months) Tacrolimus level (>3 months) Margarit et al (2005) 57 ± 7 End-stage liver cirrhosis 0.05 mg/kg twice daily 10-15 ng/ml 8-12 ng/ml Margreiter et al (2002) 42.4 ± 10.4 End-stage renal disease 0.15 mg/kg twice daily 10-20 ng/ml 5-15 ng/ml Mayer et al (1997) 46.6 ± 25 End-stage renal disease 0.15 mg/kg twice daily 10-20 ng/ml 5-15 ng/ml Moench et al (2007) 53.5 ± 8.3 End-stage liver disease 0.20 mg/kg twice daily 10-15 ng/ml 5-10 ng/ml Murphy et al (2003) 45 ± 12 End-stage renal disease 0.10 mg/kg twice daily 8-15 ng/ml 5-10 ng/ml O'grady et al (2002) 52 ± 10 End-stage liver cirrhosis 0.10 mg/kg twice daily 5-15 ng/ml 5-15 ng/ml US Multicenter (1994) 44 ± 18 End-stage liver cirrhosis 0.15 mg/kg twice daily <0.2 or >5 ng/ml if toxicity occurred <0.2 or >5 ng/ml if toxicity occurred trials", "tacrolimus and controlled trials" and "tacrolimus and organ transplantation". Sixteen articles were further evaluated and assessed for suitability to be included in this review.…”

Section: Study Namementioning

confidence: 99%

“…Five trials were conducted for twelve months (Mayer et al, 1997;Murphy et al, 2003;O'grady et al, 2002; The US Multicenter FK 506 Liver Study Group, 1994;Moench et al, 2007), one trial was conducted for five years (Margarit et al, 2005) and another one trial was conducted for six months (Margreiter et al, 2002). All trials involved adults from 42 years old to 57 years old.…”

Section: Description Of Studies Includedmentioning

confidence: 99%

See 2 more Smart Citations

A systematic review of the adverse effects of tacrolimus in organ transplant patients

Teh¹,

Dom

Zakaria

et al. 2011

Afr. J. Pharm. Pharmacol.

View full text Add to dashboard Cite

Tacrolimus has been the drug of choice for prevention of graft rejection following organ transplantations. This systematic review and meta-analysis [UiTM1] was conducted to evaluate the efficacy of tacrolimus in organ transplantation. Publication in English of randomized clinical trials, which used tacrolimus to prevent graft rejection in adult patients were included in this analysis. Articles were searched from PubMed, Science Direct, Blackwell and Ovid Gateway, which were published since 1980 to 2007. The outcomes measured were biopsy-proven acute rejection at three months; graft survival at one year; post-transplant diabetes mellitus; hypertension and neurotoxicity. Seven reports, which involved 2415 participants showed that tacrolimus was associated with reduced odds of biopsyproven acute rejections three months of post-transplantation (pooled odds ratio of 0.69; 95% CI 0.49 to 0.96) and improved graft survival at one year (pooled odds ratio of 1.11 and 95% confidence interval 0.72 to 1.71). In terms of adverse effects, tacrolimus-treated patients were significantly at high odds of developing post-transplant diabetes mellitus (pooled odds ratio of 1.90; 95% CI 1.09 to 3.30) and neurotoxicity (pooled odds ratio of 1.61; 95% CI 1.15 to 2.25) but reduced odds of developing hypertension (pooled odds ratio of 0.80; 95% CI 0.65 to 0.98). Low to moderate heterogeneity between trials existed for the incidences of biopsy-proven acute rejections, graft survival, post-transplant diabetes mellitus and incidence of hypertension; but the analysis showed a significant increment of neurotoxicity by tacrolimus.

show abstract

Glucocorticosteroid-free versus glucocorticosteroid-containing immunosuppression for liver transplanted patients

Fairfield

Penninga

Powell

et al. 2015

Cochrane Database of Systematic Reviews

View full text Add to dashboard Cite

Many of the benefits and harms of glucocorticosteroid avoidance or withdrawal remain uncertain because of the limited number of published randomised clinical trials, limited numbers of participants and outcomes, and high risk of bias in the trials. Glucocorticosteroid avoidance or withdrawal appears to reduce diabetes mellitus and hypertension whilst increasing acute rejection, glucocorticosteroid-resistant rejection, and renal impairment. We could identify no other benefits or harms of glucocorticosteroid avoidance or withdrawal. Glucocorticosteroid avoidance or withdrawal may be of benefit in selected patients, especially those at low risk of rejection and high risk of hypertension or diabetes mellitus. The optimal duration of glucocorticosteroid administration remains unclear. More randomised clinical trials assessing glucocorticosteroid avoidance or withdrawal are needed. These should be large, high-quality trials that minimise the risk of random and systematic error.

show abstract

A prospective randomized trial comparing tacrolimus and steroids with tacrolimus monotherapy in liver transplantation: the impact on recurrence of hepatitis C

Cited by 55 publications

References 33 publications

Treatment of recurrent hepatitis C virus infection in patients after liver transplantation

Treatment of recurrent hepatitis C virus infection in patients after liver transplantation

A systematic review of the adverse effects of tacrolimus in organ transplant patients

Glucocorticosteroid-free versus glucocorticosteroid-containing immunosuppression for liver transplanted patients

Contact Info

Product

Resources

About