Abstract | BACKGROUND: METHODS:
An 1:1 analysis was performed comparing 1-year outcomes of patients with pre-OLT renal dysfunction receiving a renal-sparing approach (RS): MMF (3 g/d), steroids, and delayed tacrolimus (TAC) (day 3 post-OLT; trough, 5-8 ng/mL) versus SLK: MMF (2 g/d), steroids, and immediate TAC (trough 10-12 ng/mL). RESULTS: In 84 OLT recipients (42 RS, 42 SLK) Model for End-Stage Liver Disease and creatinine were similar at OLT, with improved creatinine at 1 year (all P < .01 from OLT). Patient survival, graft function, infection, and rejection were similar at 1 year (P > .05). However, the RS patients had a higher rate of death in those requiring preoperative RRT (7/10 RRT vs 5/32 no RRT; P < .001). Of the patients on preoperative RRT, more RS patients continued to require postoperative RRT than SLK (7/10 vs 5/17; P = .04), of which there was a comparably higher death rate than those not needing postoperative RRT. CONCLUSION: This noninduction, RS protocol is effective in patients not on pre-OLT RRT. Patients on RRT pre-OLT should be considered for more aggressive renal sparing approaches (induction therapy with more delayed CNI initiation or SLK).
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Authors | V Rao, S Haywood, M Abecassis, J Levitsky |
Journal | Transplantation proceedings
(Transplant Proc)
2013 Jan-Feb
Vol. 45
Issue 1
Pg. 320-2
ISSN: 1873-2623 [Electronic] United States |
PMID | 23267806
(Publication Type: Journal Article)
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Copyright | Copyright © 2013 Elsevier Inc. All rights reserved. |
Chemical References |
- Calcineurin Inhibitors
- Immunosuppressive Agents
- Steroids
- Mycophenolic Acid
- Tacrolimus
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Topics |
- Calcineurin Inhibitors
- Case-Control Studies
- Drug Administration Schedule
- Female
- Humans
- Immunosuppressive Agents
(therapeutic use)
- Kidney
(physiology)
- Liver Transplantation
(methods)
- Male
- Middle Aged
- Mycophenolic Acid
(administration & dosage, analogs & derivatives)
- Postoperative Complications
- Renal Replacement Therapy
(methods)
- Steroids
(therapeutic use)
- Tacrolimus
(administration & dosage)
- Treatment Outcome
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