Low Total Dose of Anti-Human T-Lymphocyte Globulin (ATG) Guarantees a Good Glomerular Filtration Rate after Liver Transplant in Recipients with Pretransplant Renal Dysfunction

Dopazo, Cristina; Charco, Ramón; Caralt, M.; Pando, Elizabeth; Lázaro, José; Gómez‐Gavara, Concepción; Castells, L.; Bilbao, Itxarone

doi:10.1155/2018/1672621

Cited by 7 publications

(16 citation statements)

References 32 publications

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“…In KT recipients, recently published economic evaluations of NDI and DI have been favorable, with ATG often being preferred . However, cost‐effectiveness studies of induction in LT remain extremely limited . Dopazo et al found comparable improvements in post‐LT renal function and rejection risk, but significant cost‐savings at their hospital in Spain, when using a low‐dose equine ATG (ATGAM; Pfizer) protocol vs standard basiliximab in recipients with pre‐LT renal impairment.…”

Section: Discussionmentioning

confidence: 99%

“…However, cost‐effectiveness studies of induction in LT remain extremely limited . Dopazo et al found comparable improvements in post‐LT renal function and rejection risk, but significant cost‐savings at their hospital in Spain, when using a low‐dose equine ATG (ATGAM; Pfizer) protocol vs standard basiliximab in recipients with pre‐LT renal impairment. Further studies are needed to estimate the financial impact of a more uniform use of induction in adult LT recipients in the United States.…”

Section: Discussionmentioning

confidence: 99%

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The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

Bittermann

Hubbard

Goldberg

2019

American Journal of Transplantation

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The use of induction immunosuppression in liver transplantation (LT) remains controversial. This was a retrospective cohort study of adult, first‐time liver‐alone recipients (N = 69 349) at 114 US centers between 2005 and 2018 using data from the United Network for Organ Sharing. The comparative effectiveness of nondepleting and depleting induction (NDI and DI) was assessed. Overall, 27% of recipients received induction with 65.7% of the variance in the receipt of induction being attributed to transplant center alone. NDI and DI were associated with a lower risk of death/graft failure compared to no induction (adjusted hazard ratio 0.90 [95% confidence interval (CI): 0.86‐0.95] and 0.91 [95% CI: 0.85‐0.97], respectively; P < .001). In nondialysis recipients at the mean transplant estimated glomerular filtration rate (eGFR), NDI was associated with an adjusted gain in eGFR by 6 months of +3.8 mL/min per 1.73 m2 and DI of +3.33 mL/min per 1.73 m2 compared to no induction (P < .001). Recipients with lower eGFR at LT had greater predicted improvement in eGFR (interaction P < .001). Only NDI was associated with a reduced risk of acute rejection in the first year post‐LT (odds ratio 0.87, 95% CI: 0.8‐0.94). Significant variability in induction practices exists, with center being a major determinant. The absolute incremental benefits of NDI and DI over no induction were small.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

Bittermann

Hubbard

Goldberg

2019

American Journal of Transplantation

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“…When information was available, ≥78.1% of patients were White; the exception was Chauhan et al, in which 36.3–43.3% of patients across study arms were White [ 20 ]. The primary diseases at baseline varied between studies and study arms ( Table 4 ), but included alcoholism or ethanol abuse (23.1–71.4% across 3 studies [ 23 , 24 , 29 ]) hepatitis C virus infection (0–41.8% in 11 studies [ 7 , 19 , 20 , 22 – 26 , 28 – 30 ]), and hepatocellular carcinoma (2.3–63.6% in 10 studies [ 7 , 19 – 22 , 24 , 27 – 30 ]).…”

Section: Baseline Characteristicsmentioning

confidence: 99%

“…Renal function at baseline and during follow-up varied markedly between studies and treatment regimens ( Table 5 ). From baseline values, mean GFR/eGFR remained stable or improved over time in at least 1 study arm from 4 publications [ 18 , 22 , 23 , 29 ]. Mean±SD eGFR increased numerically from baseline in patients receiving tacrolimus+MMF+steroid+telbivudine (from 77.3 to 88.9 mL/min at 12 months [means within CKD stage 2] [ 18 ]) and in non-betel nut chewers receiving once-daily tacrolimus (from 72.2±21.9 to 77.8 mL/min/1.73 m 2 at 17 months [means within CKD stage 2] [ 23 ]).…”

Section: Renal Functionmentioning

confidence: 99%

A Systematic Review of the Literature on Chronic Kidney Disease Following Liver Transplantation

2022

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Chronic kidney disease (CKD) is a serious comorbidity affecting liver transplant recipients (LTRs). Calcineurin inhibitor dosing minimization protocols and everolimus use purportedly increased from 2010, potentially impacting CKD development. This systematic literature review was designed to identify CKD incidence in adult LTRs, focusing on studies published from 2010 onwards. PubMed, Embase, and the Cochrane Database of Systematic Reviews were searched for papers reporting renal function (glomerular filtration rate [GFR]; estimated GFR [eGFR] or Chronic Kidney Disease Epidemiology Collaboration) for adult LTRs ≥6 months after transplantation. Primary outcome: renal function ≥6 months after transplantation, with CKD stage. Bias was assessed using the Cochrane Collaboration bias tool and by reviewing disclosures/industry funding. Of 3960 records identified, 14 publications were included. In at least 1 study arm, mean GFR/eGFR remained stable/improved temporally in 4 and decreased in 8 publications. Where GFR/eGFR decreased, mean eGFR was 71.4–119.6 mL/min/1.73 m 2 (CKD stage 2-stage 1) across studies at baseline, and was 77.2 and 79.1 mL/min/1.73 m 2 (stage 2) at 12 months. The proportion of patients with CKD increased between baseline and follow-up; 23.2–36.8% of patients had CKD stage 3a or higher at 12 months (2 studies). Rates ranged from 85.7–100% (6 months) for patient survival, 81.0% (12 months) to 100.0% (17 months) for graft survival, and 0–40% (12 months) for acute rejection. Most studies carried risk of bias. Evidence of temporal renal function decline highlights the need for continuous renal monitoring of LTRs, particularly regarding potential CKD development/progression.

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“…All patients received MMF plus a bolus of corticosteroid (not followed by maintenance steroids). The incidence of acute cellular rejection (BPAR) and renal outcomes were better in the basiliximab group (104,105). Even though these studies have not been designed for NASH patients, however considering a higher incidence of renal dysfunction, low dose tacrolimus regimens should be considered in patients with NASH beyond 3 months as a strategy to prevent renal compromise post-LT.…”

Section: Post-transplant Renal Dysfunctionmentioning

confidence: 99%

Peri-transplant renal dysfunction in patients with non-alcoholic steatohepatitis undergoing liver transplantation

Maiwall¹,

Gupta²

2020

Transl Gastroenterol Hepatol

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Non-alcoholic fatty liver disease (NAFLD) is currently the most common etiology of chronic liver disease (CLD) caused by an accumulation of fat in the liver and globally is the leading indication of liver transplantation. Emerging data has recognized an increased association of NAFLD with risk of other metabolic liver diseases like type 2 diabetes mellitus, chronic kidney disease (CKD) and cardiovascular diseases. Pathophysiologically, NAFLD patients have a state of low-grade systemic inflammation, insulin resistance and atherogenic dyslipidemia which causes renal dysfunction. Patients with NAFLD cirrhosis awaiting liver transplant (LT) face unique challenges and have a significantly higher requirement of simultaneous-liver-kidney transplant as compared to other etiologies. Further, NAFLD not only recurs but also occurs as a de novo manifestation post-LT. There is also a significantly higher risk of waiting list stagnation and dropouts due to burdensome cardiometabolic disorders in NAFLD patients. The current review aims to understand the prevalence and pathogenetic basis of renal dysfunction in NAFLD.Additionally, the review describes the choice of immunosuppression protocols and use of intraoperative renal replacement therapy in context of intra and post-operative renal dysfunction in NAFLD patients. Prospective controlled trials focusing on NAFLD and development of CKD are needed to assess the existence of a causal and/or a bidirectional relationship between NAFLD and CKD.

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Low Total Dose of Anti-Human T-Lymphocyte Globulin (ATG) Guarantees a Good Glomerular Filtration Rate after Liver Transplant in Recipients with Pretransplant Renal Dysfunction

Cited by 7 publications

References 32 publications

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

The use of induction therapy in liver transplantation is highly variable and is associated with posttransplant outcomes

A Systematic Review of the Literature on Chronic Kidney Disease Following Liver Transplantation

Peri-transplant renal dysfunction in patients with non-alcoholic steatohepatitis undergoing liver transplantation

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