A cross-sectional analysis of long-term immunosuppressive regimens after liver transplantation at Asan Medical Center: Increased preference for mycophenolate mofetil

Hwang, Shin; Ahn, Curie; Kim, Ki‐Hun; Moon, Deok‐Bog; Ha, Tae‐Yong; Song, Gi‐Won; Jung, Dong‐Hwan; Park, Gil‐Chun

doi:10.14701/ahbps.2018.22.1.19

Cited by 17 publications

(21 citation statements)

References 36 publications

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“…Transfusion was performed to maintain INR < 2.0, fibrinogen >100 mg dL −1 , and platelet counts > 30 000 mm −3 . Immunosuppression protocols consisted of basiliximab induction and an intraoperative steroid bolus of 5‐10 mg kg −1 , as previously described . Post‐LDLT, tacrolimus or cyclosporine‐based therapy with adjunctive mycophenolate mofetil was used, and corticosteroids were rapidly tapered off within the first 3 months.…”

Section: Methodsmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Kwon

Moon

Jung

et al. 2019

Liver International

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Background & Aims:Early allograft dysfunction (EAD) is predictive of poor graft and patient survival following living donor liver transplantation (LDLT). Considering the impact of the inflammatory response on graft injury extent following LDLT, we investigated the association between neutrophil-to-lymphocyte ratio (NLR) and EAD, 1year graft failure, and mortality following LDLT, and compared it to C-reactive protein (CRP), procalcitonin, platelet-to-lymphocyte ratio and the Glasgow prognostic score. Methods:A total of 1960 consecutive adult LDLT recipients (1531/429 as development/validation cohort) were retrospectively evaluated. Cut-offs were derived using the area under the receiver operating characteristic curve (AUROC), and multivariable regression and Cox proportional hazard analyses were performed.Results: The risk of EAD increased proportionally with increasing NLR, and the NLR AUROC was 0.73, similar to CRP and procalcitonin and higher than the rest. NLR ≥ 2.85 (best cut-off) showed a significantly higher EAD occurrence (20.5% vs 5.8%, P < 0.001), higher 1-year graft failure (8.2% vs 4.9%, log-rank P = 0.009) and higher 1-year mortality (7% vs 4.5%, log-rank P = 0.039). NLR ≥ 2.85 was an independent predictor of EAD (odds ratio, 1.89 [1.26-2.84], P = 0.002) after multivariable adjustment, whereas CRP and procalcitonin were not. Increasing NLR was independently associated with higher 1-year graft failure and mortality (both P < 0.001).Consistent results in the validation cohort strengthened the prognostic value of NLR. Conclusions:Preoperative NLR ≥ 2.85 predicted higher risk of EAD, 1-year graft failure and 1-year mortality following LDLT, and NLR was superior to other parameters, suggesting that preoperative NLR may be a practical index for predicting graft function following LDLT. K E Y W O R D S early allograft dysfunction, inflammatory status, living donor liver transplantation, neutrophilto-lymphocyte ratio S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Kwon H-M, Moon Y-J, Jung K-W, et al.Neutrophil-to-lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation. Liver

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Section: Methodsmentioning

confidence: 99%

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Kwon

Moon

Jung

et al. 2019

Liver International

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“…33 Our previous study presented that the overall administration rate of everolimus is not high, but its use is gradually increasing with the expansion of indications. 16 Everolimus monotherapy has also been adopted,…”

Section: Discussionmentioning

confidence: 99%

Pretransplant Hepatic Malignancy Increases Risk of De Novo Malignancy after Liver Transplantation

et al. 2020

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Background: Hepatocellular carcinoma (HCC) recurrence and development of de novo malignancy (DNM) after liver transplantation (LT) are the major causes of late recipient death. Methods: We analyzed the incidence of extrahepatic DNM following living donor LT according to the status of pretransplant hepatic malignancy. We selected 2,076 adult patients who underwent primary LDLT during 7 years from January 2010 to December 2016. Results: The pretransplant hepatic malignancy group (n = 1,012) showed 45 cases (4.4%) of the following extrahepatic DNMs: posttransplant lymphoproliferative disease (PTLD) in 10; lung cancer in 10; stomach cancer in 6; colorectal cancer in 5; urinary bladder cancer in 3; and other cancers in 11. The pretransplant no hepatic malignancy group (n = 1,064) showed 25 cases (2.3%) of the following extrahepatic DNMs: colorectal cancer in 3; stomach cancer in 3; leukemia in 3; lung cancer in 3; PTLD in 2; prostate cancer in 2; and other cancers in 9. Incidences of extrahepatic DNM in the pretransplant hepatic malignancy and no hepatic malignancy groups were as follows: 1.1% and 0.5% at 1 year, 3.2% and 2.0% at 3 years, 4.6% and 2.5% at 5 years, and 5.4% and 2.8% at 8 years, respectively (P = 0.006). Their overall patient survival rates were as follows: 97.3% and 97.2% at 1 year, 91.6% and 95.9% at 3 years, 89.8% and 95.4% at 5 years, and 89.2% and 95.4% at 8 years, respectively (P < 0.001). Pretransplant hepatic malignancy was the only significant risk factor for posttransplant extrahepatic DNM. Conclusion: Our results suggest that patients who had pretransplant hepatic malignancy be followed up more strictly because they have a potential risk of primary hepatic malignancy recurrence as well as a higher risk of extrahepatic DNM than patients without pretransplant hepatic malignancy.

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“…The primary immunosuppressive protocols used to treat adult LT recipients at our institution included an interleukin‐2 receptor inhibitor, an intraoperative steroid bolus, an intravenous or oral calcineurin inhibitor, and corticosteroid recycling beginning on day 1, with adjunctive mycophenolate mofetil administered to patients showing calcineurin inhibitor‐associated adverse effects or to augment immunosuppression . Institutional indications for administration of mammalian target of rapamycin inhibitors include HCC recurrence, pretransplant or de novo malignancy, and renal dysfunction.…”

Section: Methodsmentioning

confidence: 99%

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

Park

Hwang

Song

et al. 2020

J Hepato Biliary Pancreat

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Background: This study analyzed treatment and outcomes in patients with primary extrahepatic malignancy (EHM) incidentally diagnosed during pretransplant evaluation for living donor liver transplantation (LDLT). Methods: Of 4621 adult patients undergoing LDLT over 19 years, 41 were diagnosed with EHM shortly before LDLT (incidental malignancy group), and 92 had been treated for EHM more than 6 months before LDLT (treated malignancy group). Results: Most common EHMs were colorectal, thyroid, and stomach cancers in the incidental malignancy group; and stomach, breast, thyroid, colorectal, and renal cell cancers and lymphoma in the treated malignancy group. Mean interval between EHM diagnosis and LDLT in the incidental malignancy group was 1.5 ± 1.6 months. Of the 41 patients in this group, 15 (35.6%), seven (17.1%), and 16 (39.0%) underwent EHM treatment before, during, and after LDLT, respectively, whereas three (7.3%) underwent observation alone.During a mean follow-up of 70.1 ± 50.8 months, six (14.6%) patients showed tumor recurrence, and three (7.3%) died of tumor progression. All recurrences developed in patients with tumor stages higher than the earliest stage. The mean interval between EHM diagnosis and LDLT in treated malignancy group was 79.8 ± 79.6 months. During a mean follow-up of 63.2 ± 54.1 months, three (3.3%) patients showed tumor recurrence and one (1.1%) died of tumor progression. The incidence of EHM recurrence was significantly higher (P = .025), and the overall post-transplant patient survival rate was significantly lower (P = .046), in the incidental malignancy than in the treated malignancy group. Conclusions: Only patients with earliest-stage EHM detected shortly before LDLT are indicated for upfront LDLT combined with peritransplant EHM treatment. K E Y W O R D Shepatocellular carcinoma, living donor liver transplantation, malignancy, recurrence, surveillance

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A cross-sectional analysis of long-term immunosuppressive regimens after liver transplantation at Asan Medical Center: Increased preference for mycophenolate mofetil

Cited by 17 publications

References 36 publications

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Neutrophil‐to‐lymphocyte ratio is a predictor of early graft dysfunction following living donor liver transplantation

Pretransplant Hepatic Malignancy Increases Risk of De Novo Malignancy after Liver Transplantation

Treatment and outcomes of extrahepatic malignancy incidentally diagnosed during pretransplant evaluation for living donor liver transplantation

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