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The benefit of sirolimus maintenance immunosuppression and rabbit antithymocyte globulin induction in liver transplant recipients that develop acute kidney injury in the early postoperative period.

Duhart BT, Ally WA, Krauss AG, Hudson JQ, Eason JD, Rao V, Vanatta JM - J Transplant (2015)

Bottom Line: Demographics were similar between groups except for a higher incidence of pretransplant renal dysfunction in the SRL recipients (SRL 59% versus TAC 21%; P < 0.05).The eGFR was significantly (P < 0.05) higher for all time points in the TAC group with the exception of month 2.However, improvement in eGFR was significantly (P < 0.05) greater in the SRL group postoperatively.

View Article: PubMed Central - PubMed

Affiliation: University of Tennessee College of Pharmacy, Memphis, TN 38163, USA ; Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN 38103, USA.

ABSTRACT
Published data are limited describing renal outcomes in orthotopic liver transplant (OLT) recipients prescribed sirolimus (SRL) maintenance immunosuppression (MIS) and rabbit antithymocyte globulin (rATG) induction. We investigated whether SRL MIS and rATG induction facilitated recovery of acute kidney injury in the early postoperative period. This retrospective descriptive study screened 308 consecutive OLTs performed between 2006 and 2009. All patients received rATG induction with steroid avoidance. MIS consisted of SRL or TAC with mycophenolate mofetil. A total of 197 patients were included: 168 (85%) received TAC and 29 (15%) received SRL for a median of 365 days. Demographics were similar between groups except for a higher incidence of pretransplant renal dysfunction in the SRL recipients (SRL 59% versus TAC 21%; P < 0.05). The eGFR was significantly (P < 0.05) higher for all time points in the TAC group with the exception of month 2. However, improvement in eGFR was significantly (P < 0.05) greater in the SRL group postoperatively. Our study suggests that rATG induction and SRL maintenance immunosuppression facilitate renal recovery for liver transplant recipients that develop acute kidney injury in the early postoperative period.

No MeSH data available.


Related in: MedlinePlus

Comparison of mean serum creatinine between SRL (n = 29) and TAC (n = 168) groups over 1-year follow-up after transplant (P < 0.05 at all time points).
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Related In: Results  -  Collection


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fig1: Comparison of mean serum creatinine between SRL (n = 29) and TAC (n = 168) groups over 1-year follow-up after transplant (P < 0.05 at all time points).

Mentions: Renal function was compared using both serum creatinine and the eGFR. Serum creatinine was significantly elevated, and conversely, eGFR significantly decreased in patients receiving SRL on the day of MIS initiation. Serum creatinine and eGFR values converged in month 2 and then began to stabilize in months 3–12, respectively (Figures 1 and 2). At 1-year follow-up, serum creatinine and eGFR between groups were significantly different (P < 0.05). The change in eGFR from the initiation of immunosuppression to 1, 2, 3, 6, and 12 months after transplant showed a significant increase at each time point in the SRL group as compared to the decrease in eGFR seen in the TAC group (Figure 3). The change in eGFR reflects a sustained improvement in renal function over the first year after transplant in the SRL group, and no patients progressed to renal replacement therapy after discharge from primary hospitalization (Table 2).


The benefit of sirolimus maintenance immunosuppression and rabbit antithymocyte globulin induction in liver transplant recipients that develop acute kidney injury in the early postoperative period.

Duhart BT, Ally WA, Krauss AG, Hudson JQ, Eason JD, Rao V, Vanatta JM - J Transplant (2015)

Comparison of mean serum creatinine between SRL (n = 29) and TAC (n = 168) groups over 1-year follow-up after transplant (P < 0.05 at all time points).
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4377545&req=5

fig1: Comparison of mean serum creatinine between SRL (n = 29) and TAC (n = 168) groups over 1-year follow-up after transplant (P < 0.05 at all time points).
Mentions: Renal function was compared using both serum creatinine and the eGFR. Serum creatinine was significantly elevated, and conversely, eGFR significantly decreased in patients receiving SRL on the day of MIS initiation. Serum creatinine and eGFR values converged in month 2 and then began to stabilize in months 3–12, respectively (Figures 1 and 2). At 1-year follow-up, serum creatinine and eGFR between groups were significantly different (P < 0.05). The change in eGFR from the initiation of immunosuppression to 1, 2, 3, 6, and 12 months after transplant showed a significant increase at each time point in the SRL group as compared to the decrease in eGFR seen in the TAC group (Figure 3). The change in eGFR reflects a sustained improvement in renal function over the first year after transplant in the SRL group, and no patients progressed to renal replacement therapy after discharge from primary hospitalization (Table 2).

Bottom Line: Demographics were similar between groups except for a higher incidence of pretransplant renal dysfunction in the SRL recipients (SRL 59% versus TAC 21%; P < 0.05).The eGFR was significantly (P < 0.05) higher for all time points in the TAC group with the exception of month 2.However, improvement in eGFR was significantly (P < 0.05) greater in the SRL group postoperatively.

View Article: PubMed Central - PubMed

Affiliation: University of Tennessee College of Pharmacy, Memphis, TN 38163, USA ; Methodist University Hospital Transplant Institute, University of Tennessee Health Science Center, Memphis, TN 38103, USA.

ABSTRACT
Published data are limited describing renal outcomes in orthotopic liver transplant (OLT) recipients prescribed sirolimus (SRL) maintenance immunosuppression (MIS) and rabbit antithymocyte globulin (rATG) induction. We investigated whether SRL MIS and rATG induction facilitated recovery of acute kidney injury in the early postoperative period. This retrospective descriptive study screened 308 consecutive OLTs performed between 2006 and 2009. All patients received rATG induction with steroid avoidance. MIS consisted of SRL or TAC with mycophenolate mofetil. A total of 197 patients were included: 168 (85%) received TAC and 29 (15%) received SRL for a median of 365 days. Demographics were similar between groups except for a higher incidence of pretransplant renal dysfunction in the SRL recipients (SRL 59% versus TAC 21%; P < 0.05). The eGFR was significantly (P < 0.05) higher for all time points in the TAC group with the exception of month 2. However, improvement in eGFR was significantly (P < 0.05) greater in the SRL group postoperatively. Our study suggests that rATG induction and SRL maintenance immunosuppression facilitate renal recovery for liver transplant recipients that develop acute kidney injury in the early postoperative period.

No MeSH data available.


Related in: MedlinePlus