How Long Should Initiation of Calcineurin Inhibitors Be Delayed to Protect Renal Function in Liver Transplantation?

Rafael-Valdivia, L.; Mendoza, María Alexandra Arias; Martinez-Saldivar, B.; Sánchez‐Fueyo, Alberto; Brunet, Mercè; García‐Valdecasas, Juan Carlos; Rimola, Antoni

doi:10.1016/j.transproceed.2011.01.091

Cited by 5 publications

(7 citation statements)

References 6 publications

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“…Though AKIN is not validated for use as an outcome in clinical research, it does represent a secondary method for representing change in renal function relative to baseline. These findings also represent another signal toward a potential benefit of delaying CNI initiation to achieve a greater degree of post‐operative RR These results are somewhat dissimilar to those reported by Rafael‐Valdivia et al in which delayed CNI initiation to POD 5 resulted in improved long‐term renal function compared to CNI initiation within the first four post‐operative days . These patients did not receive basiliximab induction and, per‐protocol, were exposed to higher CNI concentration targets than were patients in our cohort.…”

Section: Discussioncontrasting

confidence: 81%

“…These findings also represent another signal toward a potential benefit of delaying CNI initiation to achieve a greater degree of post-operative RR These results are somewhat dissimilar to those reported by Rafael-Valdivia et al in which delayed CNI initiation to POD 5 resulted in improved long-term renal function compared to CNI initiation within the first four post-operative days. 17 These patients did not receive basiliximab induction and, perprotocol, were exposed to higher CNI concentration targets than were patients in our cohort. Further, neither baseline characteristics that might be expected to influence long-term renal function nor post-operative CNI concentrations were reported in this study.…”

Section: Discussionmentioning

confidence: 82%

“…Specifically, there are limited data guiding clinicians in the decision of when to initiate therapy with a CNI. Rafael‐Valdivia and colleagues identified in multivariate analysis a benefit of delaying CNI initiation to post‐operative day (POD) 5 for the purpose of preserving renal function at 3‐months after liver transplantation . However, this study did not involve IL‐2R antagonist therapy, nor did it consider other important outcomes such as the incidence of cellular rejection.…”

Section: Introductionmentioning

confidence: 99%

“…for the purpose of preserving renal function at 3-months after liver transplantation. 17 However, this study did not involve IL-2R antagonist therapy, nor did it consider other important outcomes such as the incidence of cellular rejection.…”

mentioning

confidence: 99%

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Delayed calcineurin inhibitor introduction and renal outcomes in liver transplant recipients receiving basiliximab induction

Lange

Salerno

Sammons

et al. 2018

Clinical Transplantation

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Background To investigate the impact of delayed calcineurin inhibitor (CNI) initiation in liver transplant recipients (LTR) with peri‐operative renal insufficiency receiving basiliximab induction, we compared renal outcomes of LTR stratified by the degree of achieved post‐operative renal recovery (RR) prior to CNI initiation. Methods All adult LTR transplanted between 01/2007 and 12/2015 who received basiliximab were included. Patients who received multi‐organ transplantations, were repeat transplant recipients, or expired prior to post‐operative day (POD) 90 were excluded. The primary outcome of our retrospective analysis was renal function at POD 90. Results A total of 210 patients were included in our final analysis. Most patients were Caucasian males undergoing liver transplantation for liver disease secondary to hepatitis C virus. Baseline characteristics were similar among the evaluable population. Estimated GFR was significantly higher among patients with the greatest degree of post‐operative renal recovery at POD 90; however, this difference did not persist at POD 180. There was no significant difference in incidence or severity of biopsy‐proven acute rejection (BPAR) at any measured time point. Conclusions Delayed CNI initiation following liver transplantation in patients with post‐operative renal insufficiency who receive basiliximab induction does not adversely affect the incidence of BPAR or long‐term renal outcomes.

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 82%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Delayed calcineurin inhibitor introduction and renal outcomes in liver transplant recipients receiving basiliximab induction

Lange

Salerno

Sammons

et al. 2018

Clinical Transplantation

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“…When analyzing the postoperative factors, there is significant evidence for the role of immunosuppression drugs such as calcineurin inhibitors in renal dysfunction after OLT [20]. However, this discussion is not within the scope of this paper; here, we address the factors related mainly to pre and intraoperative period.…”

Section: Discussionmentioning

confidence: 99%

Role of MELD Score and Serum Creatinine as Prognostic Tools for the Development of Acute Kidney Injury after Liver Transplantation

et al. 2013

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BackgroundThe role of the Model for End-Stage Liver Disease (MELD) score in predicting complications, such as Acute Kidney Injury (AKI), after orthotopic liver transplantation (OLT) has yet to be evaluated and serum creatinine may be too heavily weighted in the existing MELD formula, since it has many pitfalls in cirrhotic patients.MethodsRetrospective data of the perioperative period from consecutive adult OLTs performed from January to December 2009 were recorded. Univariate and multivariate analysis were performed to analyze the risk factors for AKI and mortality after OLT.ResultsThere were 114 OLTs performed in the study period, 22 (19,2%) were submitted to dialysis prior OLT and were excluded from the analysis for AKI. The median age was 52 years and 66% were male. Median creatinine value was 0.85mg/dL and MELD was 19. Fifty-two of the 92 patients (56,5%) developed AKI in the first 72 hours after OLT. The only independent risk factor for AKI was calculated MELD and when the components of the MELD score were analyzed, INR had a much stronger impact in predicting AKI then serum creatinine. Overall mortality rate was 32,5% and anesthesia duration was the only variable associated with higher mortality rate.ConclusionsAlthough MELD score seems to have a good performance in predicting AKI after OLT, serum creatinine had no impact on its prediction despite its importance on MELD calculation. Modifying the MELD score, which could include novel AKI biomarkers, may improve its prognostic accuracy and provide a better tool for public health planning.

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Detección precoz, prevención y manejo de la insuficiencia renal en el trasplante hepático

Castells¹,

Baliellas²,

Bilbao³

et al. 2014

Gastroenterología y Hepatología

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How Long Should Initiation of Calcineurin Inhibitors Be Delayed to Protect Renal Function in Liver Transplantation?

Cited by 5 publications

References 6 publications

Delayed calcineurin inhibitor introduction and renal outcomes in liver transplant recipients receiving basiliximab induction

Delayed calcineurin inhibitor introduction and renal outcomes in liver transplant recipients receiving basiliximab induction

Role of MELD Score and Serum Creatinine as Prognostic Tools for the Development of Acute Kidney Injury after Liver Transplantation

Detección precoz, prevención y manejo de la insuficiencia renal en el trasplante hepático

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