Real-World Multicenter Experience of Immunosuppression Minimization Among 661 Liver Transplant Recipients.

Aguiar, D. ; Martínez-Urbistondo, D. ; Baroja-Mazo, A. ; de la Mata, M. ; Rodríguez-Perálvarez, M. ; Rubín, A. ; Puchades, L. ; Serrano, T. (Universidad de Zaragoza) ; Montero, J. ; Cuadrado, A. ; Casafont, F. ; Salcedo, M. ; Rincón, D. ; Pons, J.A. ; Herrero, J.I.

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.)