TY  - JOUR
A1  - Trunečka, Pavel
A1  - Klempnauer, Jürgen
A1  - Bechstein, Wolf Otto
A1  - Pirenne, Jacques
A1  - Bennet, William
A1  - Zhao, Alexey
A1  - Isoniemi, Helena
A1  - Rostaing, Lionel
A1  - Settmacher, Utz
A1  - Mönch, Christian
A1  - Brown, Malcolm
A1  - Undre, Nasrullah
A1  - Kazeem, Gbenga
A1  - Tisone, Giuseppe
T1  - The effect of donor age and recipient characteristics on renal outcomes in patients receiving prolongedrelease tacrolimus after liver transplantation: Post-hoc analyses of the diamond study
T2  - Annals of transplantation
N2  - Background: The DIAMOND study of de novo liver transplant patients showed that prolonged-release tacrolimus exposure in the acute post-transplant period maintained renal function over 24 weeks of treatment. To assess these findings further, we performed a post-hoc analysis in patients according to baseline kidney function, Model for End-stage Liver Disease [MELD] scores, and donor age.
Material/Methods: Patients received prolonged-release tacrolimus (initial-dose, Arm 1: 0.2 mg/kg/day, Arm 2: 0.15-0.175 mg/kg/day, Arm 3: 0.2 mg/kg/day delayed until Day 5), mycophenolate mofetil and 1 steroid bolus. Arms 2 and 3 also received basiliximab. The recommended tacrolimus target trough levels to Day 42 post-transplantation were 5-15 ng/mL in all arms. In this post-hoc analysis, change in renal outcome, based on estimated glomerular filtration rate (eGFR), Modified Diet in Renal Disease-4 (MDRD4), values from baseline to Week 24 ­post-transplantation, were assessed according to baseline patient factors: eGFR (≥60 and ˂60 mL/min/1.73 m²), MELD score (˂25 and ≥25) and donor age (˂50 and ≥50 years).
Results: Baseline characteristics were comparable (Arms 1-3: n=283, n=287, n=274, respectively). Patients with baseline renal function, eGFR ≥60 mL/min/1.73 m², experienced a decrease in eGFR in all tacrolimus treatment arms. In patients with lower baseline renal function (eGFR ˂60 mL/min/1.73 m²), an advantage for renal function was observed with both the early lower-dose and delayed higher-dose tacrolimus regimens compared with the early introduction of higher-dose tacrolimus. At Week 24, renal function was higher in the early-lower tacrolimus arm with older donors, and the delayed higher-dose tacrolimus arm with younger donors, both compared with early higher-dose tacrolimus.
Conclusions: Pre-transplantation factors, such as renal function and donor age, could guide the choice of prolonged-release tacrolimus regimen following liver transplantation.
KW  - Glomerular Filtration Rate
KW  - Immunosuppressive Agents
KW  - Liver Transplantation
KW  - Tacrolimus
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/52546
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-525464
SN  - 1425-9524
SN  - 2329-0358
N1  - This paper has been published under Creative Common Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.
VL  - 24
SP  - 319
EP  - 327
PB  - Polish Transplantation Society with the co-operation of the Czech Transplantation Society and the Hungarian Transplantation Society
CY  - Warsaw
ER  -