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A Decade of Experience Using mTor Inhibitors in Liver Transplantation.

Campsen J, Zimmerman MA, Mandell S, Kaplan M, Kam I - J Transplant (2011)

Bottom Line: We used mortality and graft loss as the primary measures of outcome.There were no significant differences in mortality or graft loss.There was no difference in patient or graft survival.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplant Surgery, Department of Surgery, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA.

ABSTRACT
Some studies suggest that Sirolimus (SRL) is associated with an increased risk of death in liver transplant recipients compared to treatment with calcineurin inhibitors (CNIs). We compared patients who received SRL or CNI in the first year after liver transplant. Our database included 688 patients who received a liver transplant. The patients were divided into groups. (1) CNI + MPS (mycophenolate sodium) at time of discharge. (2) CNI + MPS at time of discharge; SRL was added within the first 6 months and continued through the first year. (3) CNI + MPS at time of discharge; SRL was added within the first 6 months and discontinued before the first year. (4) SRL as primary immunosuppression. (5) SRL as primary immunosuppression and discontinued before the first year. We used mortality and graft loss as the primary measures of outcome. We also quantified renal function using the change in glomerular filtration rate (GFR), the presence of biopsy proven acute cellular reject (ACR), and steroid-resistant rejection (SRR). There were no significant differences in mortality or graft loss. There was no difference in patient or graft survival. Patients that received SRL as primary immunosuppression had 50% less rejection compared to controls.

No MeSH data available.


Related in: MedlinePlus

GFR (mL/min) outcome (mean). It depicts the glomerular filtration rate (GFR) (mL/min) for the five categories of patients at the times of hospital discharge, 6 months, and 1 year.
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fig3: GFR (mL/min) outcome (mean). It depicts the glomerular filtration rate (GFR) (mL/min) for the five categories of patients at the times of hospital discharge, 6 months, and 1 year.

Mentions: Figure 3 depicts the glomerular filtration rate (GFR) (mL/min) for the five groups of patients at the times of hospital discharge, 6 months, and 1 year. As seen in Table 2, the median pre-transplant GFR of the Conversion Groups (2 and 3) (P  value = .0136  and .074) was significantly less compared to the Control Group 1 at time of transplantation. In Figure 3, the percent change in GFR was calculated from pre-transplant value to the value for GFR that was obtained at 1 year after transplantation. At 6 months, patients in categories 2 and 4 had a drop in mean GFR (Pvalue = .0793  and .0465) that was significantly more than the corresponding drop in controls. At one year, only group 4 had a significantly worse GRF than the Control Group with a change in GRF of −17.3% (P  value = .0320). While the behavior in group 5 is similar to group 4, the sample size is lower, making the P value larger.


A Decade of Experience Using mTor Inhibitors in Liver Transplantation.

Campsen J, Zimmerman MA, Mandell S, Kaplan M, Kam I - J Transplant (2011)

GFR (mL/min) outcome (mean). It depicts the glomerular filtration rate (GFR) (mL/min) for the five categories of patients at the times of hospital discharge, 6 months, and 1 year.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3064995&req=5

fig3: GFR (mL/min) outcome (mean). It depicts the glomerular filtration rate (GFR) (mL/min) for the five categories of patients at the times of hospital discharge, 6 months, and 1 year.
Mentions: Figure 3 depicts the glomerular filtration rate (GFR) (mL/min) for the five groups of patients at the times of hospital discharge, 6 months, and 1 year. As seen in Table 2, the median pre-transplant GFR of the Conversion Groups (2 and 3) (P  value = .0136  and .074) was significantly less compared to the Control Group 1 at time of transplantation. In Figure 3, the percent change in GFR was calculated from pre-transplant value to the value for GFR that was obtained at 1 year after transplantation. At 6 months, patients in categories 2 and 4 had a drop in mean GFR (Pvalue = .0793  and .0465) that was significantly more than the corresponding drop in controls. At one year, only group 4 had a significantly worse GRF than the Control Group with a change in GRF of −17.3% (P  value = .0320). While the behavior in group 5 is similar to group 4, the sample size is lower, making the P value larger.

Bottom Line: We used mortality and graft loss as the primary measures of outcome.There were no significant differences in mortality or graft loss.There was no difference in patient or graft survival.

View Article: PubMed Central - PubMed

Affiliation: Division of Transplant Surgery, Department of Surgery, School of Medicine, University of Colorado Denver, Aurora, CO 80045, USA.

ABSTRACT
Some studies suggest that Sirolimus (SRL) is associated with an increased risk of death in liver transplant recipients compared to treatment with calcineurin inhibitors (CNIs). We compared patients who received SRL or CNI in the first year after liver transplant. Our database included 688 patients who received a liver transplant. The patients were divided into groups. (1) CNI + MPS (mycophenolate sodium) at time of discharge. (2) CNI + MPS at time of discharge; SRL was added within the first 6 months and continued through the first year. (3) CNI + MPS at time of discharge; SRL was added within the first 6 months and discontinued before the first year. (4) SRL as primary immunosuppression. (5) SRL as primary immunosuppression and discontinued before the first year. We used mortality and graft loss as the primary measures of outcome. We also quantified renal function using the change in glomerular filtration rate (GFR), the presence of biopsy proven acute cellular reject (ACR), and steroid-resistant rejection (SRR). There were no significant differences in mortality or graft loss. There was no difference in patient or graft survival. Patients that received SRL as primary immunosuppression had 50% less rejection compared to controls.

No MeSH data available.


Related in: MedlinePlus