Real-World Multicenter Experience of Immunosuppression Minimization Among 661 Liver Transplant Recipients.
Resumen: BACKGROUND Long-term morbidity and mortality in liver transplant recipients is frequently secondary to immunosuppression toxicity. However, data are scarce regarding immunosuppression minimization in clinical practice. MATERIAL AND METHODS In this cross-sectional, multicenter study, we reviewed the indications of immunosuppression minimization (defined as tacrolimus levels below 5 ng/mL or cyclosporine levels below 50 ng/mL) among 661 liver transplant recipients, as well as associated factors and the effect on renal function. RESULTS Fifty-three percent of the patients received minimized immunosuppression. The median time from transplantation to minimization was 32 months. The most frequent indications were renal insufficiency (49%), cardiovascular risk (19%), de novo malignancy (8%), and cardiovascular disease (7%). The factors associated with minimization were older age at transplantation, longer post-transplant follow-up, pre-transplant diabetes mellitus and renal dysfunction, and the hospital where the patients were being followed. The patients who were minimized because of renal insufficiency had a significant improvement in renal function (decrease of the median serum creatinine level, from 1.50 to 1.34 mg/dL; P=0.004). Renal function significantly improved in patients minimized for other indications, too. In the long term, glomerular filtration rate significantly decreased in non-minimized patients and remained stable in minimized patients. CONCLUSIONS Immunosuppression minimization is frequently undertaken in long-term liver transplant recipients, mainly for renal insufficiency. Substantial variability exists regarding the use of IS minimization among centers.
Idioma: Inglés
DOI: 10.12659/AOT.902523
Año: 2017
Publicado en: Annals of Transplantation 22 (2017), 265 - 275
ISSN: 1425-9524

Factor impacto JCR: 1.054 (2017)
Categ. JCR: TRANSPLANTATION rank: 22 / 25 = 0.88 (2017) - Q4 - T3
Categ. JCR: SURGERY rank: 156 / 200 = 0.78 (2017) - Q4 - T3

Factor impacto SCIMAGO: 0.456 - Transplantation (Q3) - Medicine (miscellaneous) (Q3)

Tipo y forma: Article (Published version)
Área (Departamento): Area Medicina (Dpto. Medicina, Psiqu. y Derm.)

Creative Commons You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you may not distribute the modified material.

Exportado de SIDERAL (2020-09-11-13:22:08)

Este artículo se encuentra en las siguientes colecciones:

 Record created 2017-05-16, last modified 2020-09-11

Versión publicada:
Rate this document:

Rate this document:
(Not yet reviewed)