The Effect of Donor Age and Recipient Characteristics on Renal Outcomes in Patients Receiving Prolonged-Release Tacrolimus After Liver Transplantation: Post-Hoc Analyses of the DIAMOND Study
| Autor: | Trunecka, P, Klempnauer, J, Bechstein, Wo, Pirenne, J, Bennet, W, Zhao, A, Isoniemi, H, Rostaing, L, Settmacher, U, Monch, C, Brown, M, Undre, N, Kazeem, G, Tisone, G |
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| Přispěvatelé: | DIAMOND study group |
| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Adult
Graft Rejection Male ACUTE KIDNEY INJURY Kidney Kidney Function Tests Tacrolimus Kidney Failure Humans FAILURE ddc:610 Chronic Aged Original Paper Transplantation Science & Technology MORTALITY Age Factors Glomerular Filtration Rate Immunosuppressive Agents Liver Transplantation Delayed-Action Preparations Female Kidney Failure Chronic Middle Aged Mycophenolic Acid Tissue Donors Transplant Recipients DYSFUNCTION Settore MED/18 MELD surgical procedures operative RISK-FACTORS Surgery Life Sciences & Biomedicine |
| Zdroj: | Annals of Transplantation |
| Popis: | 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 AND 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. ispartof: ANNALS OF TRANSPLANTATION vol:24 pages:319-327 ispartof: location:United States status: published |
| Databáze: | OpenAIRE |
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