Liver transplantation using sirolimus and minimal corticosteroids (3-day taper)
| Autor: | James F. Trotter, Gregory T. Everson, Nancy Stolpman, Thomas Trouillot, Igal Kam, T. Bak, Michael Wachs |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
Graft Rejection
Male medicine.medical_specialty medicine.medical_treatment Liver transplantation Gastroenterology Methylprednisolone Tacrolimus chemistry.chemical_compound Prednisone Internal medicine Cyclosporin a medicine Living Donors Humans Glucocorticoids Sirolimus Transplantation Creatinine Hepatology business.industry Middle Aged Surgery Liver Transplantation surgical procedures operative chemistry Cyclosporine Female business Immunosuppressive Agents medicine.drug |
| Zdroj: | Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society. 7(4) |
| ISSN: | 1527-6465 |
| Popis: | At our center, we have performed liver transplantation since 1995 with a rapid-taper steroid protocol (weaning steroids by day 14 posttransplantation). Beginning in 2000, we further reduced the use of corticosteroids to 3 days and added sirolimus to our immunosuppressive regimen. We report our experience with 39 patients who underwent liver transplantation with either tacrolimus or cyclosporin A (Neoral; Novartis Pharmaceuticals Corp., Summit, NJ) and sirolimus, with a 3-day tapered dose of corticosteroids. Thirty-two patients received a cadaveric graft and 7 patients received a right hepatic lobe from a living donor. All patients initially were administered either tacrolimus (0.1 mg/kg/d) or cyclosporin A (10 mg/kg/d) and sirolimus (6 mg/d for 1 day, followed by 2 mg/d), in addition to methylprednisolone on the first 3 days (1, 0.5, and 0.5 g/d) after transplantation. Patients were administered corticosteroids for presumptive or biopsy-proven evidence of acute cellular rejection (methylprednisolone, 1, 0.5, and 0.5 g on 3 successive days). Seventeen patients were administered tacrolimus and 22 patients were administered cyclosporin A. Six patients were excluded from analysis because they were administered sirolimus for less than 2 weeks. Mean duration of follow-up was 124 days. Patient survival was 36 of 39 patients (92%), and graft survival was 35 of 39 grafts (89%). Ten of 33 patients (30%) experienced 12 episodes of rejection (7 biopsy proven, 5 presumptive) compared with 70% in historical controls (P |
| Databáze: | OpenAIRE |
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