Tacrolimus Exposure After Liver Transplantation in Randomized Controlled Trials: Too Much for Too Long

Rodríguez‐Perálvarez, Manuel; Germani, Giacomo; Darius, Tom; Lerut, Jan; Tsochatzis, Emmanuel; Mata, Manuel de la; Burroughs, Andrew K.

doi:10.1111/ajt.12216

Cited by 8 publications

(3 citation statements)

References 6 publications

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“…Indeed, an observational study with 219 patients transplanted with HCC showed that those patients having mean trough concentrations more than 10 ng/ml for tacrolimus or more than 300 ng/ml for cyclosporine within the first 30 days after liver transplantation had nearly a three-fold increased risk of HCC recurrence, after controlling for possible confounding factors [32 ▪▪ ]. Moreover, tacrolimus trough concentrations 7–10 ng/ml within the first 30 days after liver transplantation result in similar rejection rates [33 ▪ ], halved renal impairment [33 ▪ ] and longer graft survival [34], when compared with trough concentrations more than 10 ng/ml, which is the ‘conventional’ exposure in randomized trials [35]. Therefore, tacrolimus trough concentrations 7–10 ng/ml should be the standard of care within the first month after liver transplantation, and future randomized trials should implement reduced tacrolimus trough concentrations in their design.…”

Section: Calcineurin Inhibitorsmentioning

confidence: 99%

Liver transplantation

Rodríguez‐Perálvarez

Mata

Burroughs

2014

Current Opinion in Organ Transplantation

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Purpose of reviewLong-term survival of liver transplant recipients is threatened by increased rates of de-novo malignancy and recurrence of hepatocellular carcinoma (HCC), both events tightly related to immunosuppression.Recent findingsThere is accumulating evidence linking increased exposure to immunosuppressants and carcinogenesis, particularly concerning calcineurin inhibitors (CNIs), azathioprine and antilymphocyte agents. A recent study including 219 HCC transplanted patients showed that HCC recurrence rates were halved if a minimization of CNIs was applied within the first month after liver transplant. With mammalian target of rapamycin (mTOR) inhibitors as approved immunosuppressants for liver transplant patients, pooled data from several retrospective studies have suggested their possible benefit for reducing HCC recurrence.SummaryRandomized controlled trials with sufficiently long follow-up are needed to evaluate the influence of different immunosuppression protocols in preventing malignancy after LT. Currently, early minimization of CNIs with or without mTOR inhibitors or mycophenolate seems a rational strategy for patients with risk factors for de-novo malignancy or recurrence of HCC after liver transplant. A deeper understanding of the immunological pathways of rejection and cancer would allow for designing more specific and safer drugs, and thus to prevent cancer after liver transplant.

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Section: Calcineurin Inhibitorsmentioning

confidence: 99%

Liver transplantation

Rodríguez‐Perálvarez

Mata

Burroughs

2014

Current Opinion in Organ Transplantation

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“…10 In the chronic follow-up of liver transplant recipients, telemedicine has the potential to decrease the number of outpatient visits while ensuring a continuous follow-up of the immunosuppressive drugs which should be taken within a close therapeutic window to prevent graft rejection on the one hand and infections, diabetes mellitus, de novo tumors and especially nephrotoxicity on the other hand. 11,12 The present study assessed whether telemedicine based remote monitoring program (TRMP) reached the target population as well as the safety and potential clinical benefits of TRMP for the chronic follow-up of liver transplant recipients.…”

Section: Introductionmentioning

confidence: 99%

“…In the chronic follow‐up of liver transplant recipients, telemedicine has the potential to decrease the number of outpatient visits while ensuring a continuous follow‐up of the immunosuppressive drugs which should be taken within a close therapeutic window to prevent graft rejection on the one hand and infections, diabetes mellitus, de novo tumors and especially nephrotoxicity on the other hand. 11 , 12 …”

Section: Introductionmentioning

confidence: 99%

Telemedicine based remote monitoring after liver transplantation: Feasible in a select group and a more stringent control of immunosuppression

Koc

Pierco

Remans

et al. 2021

Clinical Transplantation

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Telemedicine gained interest in liver transplant patients but focused until now on the early post-operative period. This prospective cohort study assessed feasibility, safety, and clinical beneficial effects of a telemedicine based remote monitoring program (TRMP) for the chronic follow-up of adult liver transplant recipients. Between November 2017 and August 2019, a total of 87 of the 115 selected patients (76%) started the TRMP. Over the 2 years study period, none of the patients switched to standard followup: 39/87 (45%) continued to do this autonomously and 48/87 (55%) stopped to report their data personally but communicated their lab values to the nurse. The other 28/115 (11%) patients who did not accept the TRMP continued the standard follow-up. There was no difference in educational level between the three groups. Remote monitoring did not result in an increase in liver graft rejection and need of hospitalization. TRMP was associated with a higher number of tacrolimus level determinations and tacrolimus blood level concentrations could be kept lower. In conclusion, our results show that in patients with a stable clinical condition there is a high willingness to participate in TRMP and that this approach is safe. Remote monitoring allowed a stringent follow-up of tacrolimus levels.

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