The impact of thymoglobulin on renal function and calcineurin inhibitor initiation in recipients of orthotopic liver transplant: a retrospective analysis of 298 consecutive patients.

Autor: Tchervenkov JI; Department of Surgery, Section of Transplantation, Royal Victoria Hospital, McGill University Health Center, Montreal, Quebec, Canada. jean.tchervenkov@much.mcgill.ca, Tzimas GN, Cantarovich M, Barkun JS, Metrakos P
Jazyk: angličtina
Zdroj: Transplantation proceedings [Transplant Proc] 2004 Jul-Aug; Vol. 36 (6), pp. 1747-52.
DOI: 10.1016/j.transproceed.2004.06.014
Abstrakt: Background: Renal dysfunction remains the Achilles' heel of calcineurin inhibitor (CI)use. The purpose of this study was to assess our institutional, renal-sparing strategy using thymoglobulin (TMG) in recipients of orthotopic liver transplants.
Methods: We performed a retrospective analysis of data from 298 adult recipients who were transplanted between 1991 and 2002. The patients were divided into two groups: those induced with TMG (group 1) and those that were not treated with this agent (group 2). A subgroup analysis was performed of patients with baseline serum creatinine values above 1.5 mg/dL (group 1A received TMG; group 2A did not). All patients received tacrolimus or cyclosporine (CyA) maintenance immunosuppression.
Results: Indications and demographics were similar between the two groups. Although there was no difference in patient and graft survivals, there was a statistically significant benefit in the rejection-free graft survival at 1 year for group 1 (51% vs 39%; P =.02). Furthermore, serum creatinine at 6 months was lower for group 1, despite a similar baseline creatinine. Subgroup analysis for patients with baseline abnormal serum creatinines showed that group 1A displayed an improved rejection-free graft survival at 1 month but not at 1 year.
Conclusions: Thymoglobulin induction therapy may allow a delay in the initiation of CI therapy without compromising patient and graft survival, while preventing early rejection, even among patients with baseline renal dysfunction.
Databáze: MEDLINE
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