Comparison of Fk506- And Cyclosporine-Based Immunosuppression in Primary Orthotopic Liver Transplantation

Neuhaus, P.; Blumhardt, G.; Bechstein, Wolf O.; Platz, K.-P.; Jonas, Sven; Mueller, Andrea; Langrehr, Jan M.; Lohmann, R; Schattenfroh, N; Knoop, M.; Keck, H.; Lemmens, P.; Raakow, R.; Lüsebrink, R.; Slama, K J; Lobeck, H.; Hopf, U.

doi:10.1097/00007890-199501150-00007

Cited by 118 publications

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“…1,13,14 In patients with impaired renal function secondary to liver failure, there is a clear advantage to allowing renal function to normalize after LT before these agents are introduced. OKT3 induction is associated with fever, aseptic meningitis, and noncardiogenic pulmonary edema, as well as profound immunosuppression and an increased risk for opportunistic infections and neoplasia, especially posttransplant lymphoproliferative disease.…”

Section: Discussionmentioning

confidence: 99%

Use of daclizumab as initial immunosuppression in liver transplant recipients with impaired renal function

et al. 2001

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The addition of daclizumab (a human immunoglobulin G1 monoclonal antibody that blocks interleukin-2 receptors on T lymphocytes) to mycophenolate mofetil (MMF) and steroids is a new option for initial immunosuppression in patients undergoing liver transplantation (LT) with impaired renal function. We evaluated the efficacy and safety of daclizumab in preventing rejection in 25 patients with impaired kidney function undergoing LT. Patients with serum creatinine (Cr) levels greater than 2 mg/dL immediately before LT were administered initial immunosuppression with daclizumab, 1 mg/kg, in addition to MMF, 2 g/d, and methylprednisolone. Tacrolimus was added after kidney function improved (when Cr levels improved by >25% of initial value). Daclizumab-treated patients were compared retrospectively with 2 other groups of patients who underwent LT with kidney impairment (Cr > 2 mg/dL): 56 patients were administered OKT3 induction, and 48 patients were administered lowdose tacrolimus. The incidence of rejection and infection (bacterial, fungal, and viral), need for preoperative and postoperative dialysis, Cr level immediately post-LT and at 3 months, and graft and patient survival were analyzed. There was no difference among the groups in 3-month Cr levels or the incidence of rejection or fungal or viral infection. The daclizumab group had fewer bacterial infections (n ‫؍‬ 13) than the tacrolimus group (n ‫؍‬ 28) and significantly fewer than the OKT3 group (n ‫؍‬ 58; P ‫؍‬ .006). Only 1 patient (4%) in the daclizumab group required dialysis post-LT versus 13 patients in each of the other groups (OKT3, 23.21%; P < .05; tacrolimus, 27%). In the daclizumab group, 2-year patient and graft survival rates were statistically significant compared with the lowdose tacrolimus group (89% and 81% v 73% and 69%, respectively; P ‫؍‬ .06). There were no side effects related to daclizumab use, and all patients tolerated the drug well. In patients with impaired renal function before LT, daclizumab-based initial immunosuppression can be used safely to reduce the risk for infection and need for dialysis post-LT, with improved long-term graft and patient survival. (Liver Transpl 2001;7:220-225.)T here is no agreement on initial immunosuppressive regimens in patients undergoing liver transplantation (LT) with impaired renal function. [1][2][3] Suggested regimens include OKT3 induction in combination with azathioprine and steroids, with or without low doses of calcineurin inhibitors. [4][5][6] A new option in this circumstance is the use of daclizumab with mycophenolate mofetil (MMF) and steroids. Daclizumab is a human immunoglobulin G1 monoclonal antibody that blocks the ␣ chain of interleukin-2 receptors on activated T lymphocytes. [7][8][9] Previous studies have shown the efficacy of daclizumab in preventing rejection in kidney transplantation and LT without immediate side effects. [7][8][9][10][11] In particular, daclizumab does not cause cytokine release syndrome, neurotoxicity, or nephrotoxicity, which makes it an appealing alternative t...

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Section: Discussionmentioning

confidence: 99%

Use of daclizumab as initial immunosuppression in liver transplant recipients with impaired renal function

et al. 2001

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“…In case of steroid-resistant rejection, OKT3, a murine monoclonal antibody against T cells (5 mg daily for 5-7 days), was administered. In patients receiving cyclosporine-based induction therapy, we switched to tacrolimus-rescue therapy (19).…”

Section: Postoperative Managementmentioning

confidence: 99%

“…Laboratory diagnosis of infection was obtained by appropriate collections of blood, sputum, and urine, as well as oral, rectal, and genital swabs for microbiological testing. Based on the test results, the initial antibiotic therapy was modified according to resistance testing (19).…”

Section: Postoperative Managementmentioning

confidence: 99%

Clinical Implications of Hepatic Preservation Injury After Adult Liver Transplantation

Glanemann

Langrehr

Stange

et al. 2003

American Journal of Transplantation

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Several advances in organ preservation have allowed for improved results after liver transplantation; however, little information is available regarding the clinical impact of preservation injury on the postoperative course. The medical records of 889 liver transplants were retrospectively reviewed. Preservation injury was classified according to postoperative aspartate aminotransferase values as minor (<1000 U/L), moderate (1000–5000 U/L), or severe (>5000 U/L). The following criteria were analyzed and compared according to the extent of preservation injury: patient and graft survival, retransplantation rate, duration of hospitalization and postoperative ventilation, as well as incidence of rejection, infection, and hemodialysis. The majority of patients received a liver with minor preservation injury (75.9%), whereas 22.7% and 1.3% of grafts showed moderate or severe injury. Graft survival was significantly lower in patients with severe preservation injury, when compared to minor or moderate injury. The relative risk for initial nonfunction was 39.36‐fold increased (95% confidence interval (ci): 10.3–150.2), as it was increased for duration of postoperative ventilation (6.92‐fold; 95%ci: 2.1–22.3) and hemodialysis (6.13‐fold; 95%ci: 1.9–19.3). Since the incidence of retransplantation was significantly increased (50%), patient survival remained comparable between all groups. Severe preservation injury had a tremendous impact on the postoperative clinical course, requiring the maximum medical effort to achieve adequate patient survival.

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“…En relación al régimen de inmunosupresión, esta variable no resultó predictora de complicaciones infecciosas. Otros estudios tampoco han demostrado que el régimen de inmunosupresión pueda constituir un factor pronóstico de complicaciones postoperatorias por infecciones (25,28).…”

Section: Discussionunclassified

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

Rodríguez‐Ariza¹,

Monrobel

Martı́nez-Galisteo³

et al. 2008

Rev. esp. enferm. dig.

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INTRODUCCIÓNEl trasplante hepático ortotópico (THO) es el tratamiento de elección para enfermedades hepáticas agudas o crónicas en estadio final. Sin embargo, el seguimiento de Factores pronósticos de complicaciones postoperatorias en el trasplante hepáticoA. Rodríguez-Ariza, A. Monrobel, E. Martínez-Galisteo 1 , C. Alicia Padilla 1 , J. A. Bárcena 1 , E. Fraga, G. Costán, P. Barrera, A. Poyato, J. L. Montero, P. López-Cillero 2 , J. Muntané y M. de la Mata RESUMENObjetivo: la evolución postoperatoria de los pacientes sometidos a trasplante hepático ortotópico (THO) se encuentra frecuentemente asociada a la aparición de diversas complicaciones tales como disfunción renal, rechazo agudo, infecciones y complicaciones neurológicas. Estas complicaciones constituyen las causas más significativas de morbilidad y mortalidad tempranas en pacientes que reciben un THO. El propósito del presente estudio es la identificación de factores relacionados con las distintas complicaciones postoperatorias del THO. Diseño experimental: se llevó a cabo un estudio prospectivo.Pacientes: se analizaron 78 variables en 32 pacientes consecutivos sometidos a THO. Utilizando un análisis de regresión logística se identificaron aquellos factores asociados de forma independiente con la aparición de complicaciones postoperatorias.Resultados: el análisis multivariante demostró que los niveles pretrasplante en suero de malondialdehído y creatinina estaban asociados con el desarrollo de disfunción renal. Los niveles pretrasplante de hemoglobina y las unidades de plaquetas administradas durante la cirugía fueron factores pronósticos de infecciones. El rechazo agudo fue pronosticado por los niveles séricos de γ-glutamil transpeptidasa y de bilirrubina total. Los niveles pretrasplante de sodio y glutaredoxina en suero estuvieron asociados con complicaciones neurológicas.Conclusiones: proponemos estos marcadores para la identificación de pacientes de alto riesgo, permitiendo una vigilancia y/o tratamiento anticipados que mejorarán la morbilidad y la supervivencia en pacientes sometidos a THO. ABSTRACTObjectives: the postoperative evolution of patients submitted to orthotopic liver transplant (OLT) is frequently associated with the appearance of different types of complications such as renal failure, graft rejection, infections, and neurological disorders. These complications are the most significant causes of early morbidity and mortality in patients undergoing OLT. The purpose of the present study was the identification of factors related to the different postoperative complications after OLT. Experimental design: a prospective study was carried out.Patients: seventy-eight variables were analyzed in 32 consecutive patients undergoing OLT. The factors independently associated with the appearance of postoperative complications were identified using a stepwise logistic regression analysis.Results: the multivariate analysis showed that malondialdehyde and creatinine pretransplant serum levels were associated with the development of renal dysfunction. T...

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Comparison of Fk506- And Cyclosporine-Based Immunosuppression in Primary Orthotopic Liver Transplantation

Cited by 118 publications

References 0 publications

Use of daclizumab as initial immunosuppression in liver transplant recipients with impaired renal function

Use of daclizumab as initial immunosuppression in liver transplant recipients with impaired renal function

Clinical Implications of Hepatic Preservation Injury After Adult Liver Transplantation

Factores pronósticos de complicaciones postoperatorias en el trasplante hepático

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