Renal impairment after liver transplantation - a pilot trial of calcineurin inhibitor-free vs. calcineurin inhibitor sparing immunosuppression in patients with mildly impaired renal function after liver transplantation

Gerhardt, Thomas; Terjung, Birgit; Knipper, Petra; Palmedo, Holger; Woitas, Rainer P.; Kalff, Jörg C.; Sauerbruch, Tilman; Spengler, Ulrich

doi:10.1186/2047-783x-14-5-210

Cited by 15 publications

(3 citation statements)

References 19 publications

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“…The prediction equation provided by our analysis can be easily programmed in electronic medical records or as a free‐standing computer application to help clinicians make decisions and inform patients at the bedside. In patients at high risk of early onset ESRD, immunosuppression regimens can potentially be altered to minimize nephrotoxic agents . In patients at high risk of late‐onset ESRD, risk factors such as hypercholesterolemia and urinary tract infections can be treated aggressively .…”

Section: Discussionmentioning

confidence: 99%

Predicting End-Stage Renal Disease After Liver Transplant

Israni

Xiong

Liu

et al. 2013

American Journal of Transplantation

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Few equations have been developed to predict endstage renal disease (ESRD) after deceased donor liver transplant. This retrospective observational cohort study analyzed all adult deceased donor liver transplant recipients in the Scientific Registry of Transplant Recipients (SRTR) database, 1995-2010. The prediction equation for ESRD was developed using candidate predictor variables available in SRTR after implementation of the allocation policy based on the model for end-stage liver disease. ESRD was defined as initiation of maintenance dialysis therapy, kidney transplant or registration on the kidney transplant waiting list. We used Cox proportional hazard models to develop separate equations for assessing risk of ESRD by 6 months posttransplant and between 6 months and 5 years posttransplant. Variables in the 6-month equation included recipient age, history of diabetes, history of dialysis before liver transplant, history of malignancy, body mass index, serum creatinine and liver donor risk index. Variables in the 6-month to 5-year equation included recipient race, history of diabetes, hepatitis C status, serum albumin, serum bilirubin and serum creatinine. The prediction equations have good calibration and discrimination (C statistics 0.74-0.78). We have produced risk prediction equations that can be used to aid in understanding the risk of ESRD after liver transplant.

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Section: Discussionmentioning

confidence: 99%

Predicting End-Stage Renal Disease After Liver Transplant

Israni

Xiong

Liu

et al. 2013

American Journal of Transplantation

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“…Since the introduction of Cyclosporine (CyA) [1], patients undergoing orthotopic liver transplantation (OLT) have achieved 5‐year survival rates between 70 and 85% [2] and a long life‐expectancy with consequent risk of developing long‐term side‐effects of immunosuppression medications [3–5]. The introduction of more recent compounds such as tacrolimus (TAC), mycophenolate mofetil (MMF), and sirolimus (SRL), has allowed physicians to choose from a larger number of medications and tailor the immunosuppression drugs to minimize their side‐effects.…”

Section: Introductionmentioning

confidence: 99%

Multicentric outcome analysis of sirolimus-based immunosuppression in 252 liver transplant recipients

Molinari

Berman

Meeberg

et al. 2010

Transplant International

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Summary The use of sirolimus (SRL) in orthotopic liver transplantation (OLT) has been controversial after experimental data suggested an increased risk of hepatic artery thrombosis (HAT). To assess the safety and efficacy of SRL as de novo immunosuppression in OLT recipients. Outcomes of 252 OLT patients who received SRL were compared with outcomes of 291 OLT recipients who received calcineurin inhibitor in a retrospective study. Primary outcomes of this study were: patient‐ and graft survivals, vascular, biliary, wound complications and rejection rates. Secondary outcomes were: postoperative infection rate, bone marrow and renal function and changes of lipid levels. Patient‐ and graft survivals, rejection and infection rates were similar. In the SRL group, HAT occurred in 1.2%, biliary complications in 19.4%, and incisional hernias in 9.1%. In the control group the incidence of HAT was 5.8% (P = 0.004), biliary complications 18.5% (P = NS) and incisional hernias 7.2% (P = NS). Patients on SRL experienced significantly higher levels of serum triglycerides but fewer acute cellular rejections. Bone marrow and renal functions were similar in both the groups. Our findings would suggest that SRL is safe and effective for very selected OLT recipients. Randomized controlled trials are necessary to confirm our results.

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“…In recent years, prospective controlled trials have established the clinical safety and efficacy of combined MMF and low-dose CNI therapy in LT patients, as documented by low incidence of allograft rejection, and progressive improvement in renal function as well as in cardiovascular risk factors [ 7 , 8 , 23 , 24 ]. Although most enrolled patients suffered from chronic CNI-related nephrotoxicity for several years, renal function improved in a significant number of converted LT patients.…”

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confidence: 99%