Pavel Trunečka, Jürgen Klempnauer, Wolf Otto Bechstein, Jacques Pirenne, William Bennet, Alexey Zhao, Helena Isoniemi, Lionel Rostaing, Utz Settmacher, Christian Mönch, Malcolm Brown, Nasrullah Undre, Gbenga Kazeem, Giuseppe Tisone
- 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.
MetadatenAuthor: | Pavel Trunečka, Jürgen KlempnauerGND, Wolf Otto BechsteinORCiDGND, Jacques Pirenne, William Bennet, Alexey Zhao, Helena Isoniemi, Lionel Rostaing, Utz Settmacher, Christian MönchGND, Malcolm Brown, Nasrullah Undre, Gbenga Kazeem, Giuseppe Tisone |
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URN: | urn:nbn:de:hebis:30:3-525464 |
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DOI: | https://doi.org/10.12659/AOT.913103 |
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ISSN: | 1425-9524 |
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ISSN: | 2329-0358 |
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Pubmed Id: | https://pubmed.ncbi.nlm.nih.gov/31160549 |
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Parent Title (English): | Annals of transplantation |
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Publisher: | Polish Transplantation Society with the co-operation of the Czech Transplantation Society and the Hungarian Transplantation Society |
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Place of publication: | Warsaw |
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Document Type: | Article |
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Language: | English |
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Year of Completion: | 2019 |
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Date of first Publication: | 2019/06/04 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Contributing Corporation: | DIAMOND study group |
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Release Date: | 2020/01/20 |
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Tag: | Glomerular Filtration Rate; Immunosuppressive Agents; Liver Transplantation; Tacrolimus |
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Volume: | 24 |
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Page Number: | 9 |
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First Page: | 319 |
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Last Page: | 327 |
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Note: | 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. |
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HeBIS-PPN: | 459376756 |
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Institutes: | Medizin / Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - Namensnennung-Nicht kommerziell - Keine Bearbeitung 4.0 |
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