Conversion From Sirolimus to Everolimus in Long-Term Liver Graft Recipients

Weiler, Nina; Bilge, Nigar; Troetschler, Sven; Vermehren, Johannes; Schnitzbauer, Andreas A.; Herrmann, Eva; Sarrazin, Christoph; Zeuzem, Stefan; Welker, Martin-Walter

doi:10.1002/jcph.871

Cited by 7 publications

(8 citation statements)

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“…Survival status of patients who were lost to follow-up was surveyed by telephone interview, in correspondence with hospitals of referral, or via public registration office inquiry. Data from individual patients may have been reported previously with respect to different topics [18][19][20].…”

Section: Methodsmentioning

confidence: 99%

Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

et al. 2021

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Objectives Rising prevalence of multidrug-resistant organisms (MDRO) is a major health problem in patients with liver cirrhosis. The impact of MDRO colonization in liver transplantation (LT) candidates and recipients on mortality has not been determined in detail. Methods Patients consecutively evaluated and listed for LT in a tertiary German liver transplant center from 2008 to 2018 underwent screening for MDRO colonization including methicillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant gram-negative bacteria (MDRGN), and vancomycin-resistant enterococci (VRE). MDRO colonization and infection status were obtained at LT evaluation, planned and unplanned hospitalization, three months upon graft allocation, or at last follow-up on the waiting list. Results In total, 351 patients were listed for LT, of whom 164 (47%) underwent LT after a median of 249 (range 0–1662) days. Incidence of MDRO colonization increased during waiting time for LT, and MRDO colonization was associated with increased mortality on the waiting list (HR = 2.57, p<0.0001. One patients was colonized with a carbapenem-resistant strain at listing, 9 patients acquired carbapenem-resistant gram-negative bacteria (CRGN) on the waiting list, and 4 more after LT. In total, 10 of these 14 patients died. Conclusions Colonization with MDRO is associated with increased mortality on the waiting list, but not in short-term follow-up after LT. Moreover, colonization with CRGN seems associated with high mortality in liver transplant candidates and recipients.

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Section: Methodsmentioning

confidence: 99%

Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

et al. 2021

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“…Follow-up care of HCC in liver graft recipients has not yet been evaluated in prospective clinical trials. Some centers suggest three-monthly chest CT scans and CT or MRI scans of the liver, and optionally bone scintigraphy, to detect recurrent HCC [19,20,21]. However, performance of repeated CT scans in putatively cured patients are particularly questionable with respect to radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, all data were pseudonymized for analysis and only non-identifiable data were published. Data from individual patients may have been reported previously with respect to different topics [20][21][22].…”

Section: Methodsmentioning

confidence: 99%

AFP ratio predicts HCC recurrence after liver transplantation

et al. 2020

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Background/aims Hepatocellular carcinoma (HCC) is a leading indication for liver transplantation (LT) worldwide. Early identification of patients at risk for HCC recurrence is of paramount importance since early treatment of recurrent HCC after LT may be associated with increased survival. We evaluated incidence of and predictors for HCC recurrence, with a focus on the course of AFP levels. Methods We performed a retrospective, single-center study of 99 HCC patients who underwent LT between January 28 th , 1997 and May 11 th , 2016. A multi-stage proportional hazards model with three stages was used to evaluate potential predictive markers, both by univariate and multivariable analysis, for influences on 1) recurrence after transplantation, 2) mortality without HCC recurrence, and 3) mortality after recurrence. Results 19/99 HCC patients showed recurrence after LT. Waiting time was not associated with overall HCC recurrence (HR = 1, p = 0.979). Similarly, waiting time did not affect mortality in LT recipients both with (HR = 0.97, p = 0.282) or without (HR = 0.99, p = 0.685) HCC recurrence. Log 10-transformed AFP values at the time of LT (HR 1.75, p = 0.023) as well as after LT (HR 2.07, p = 0.037) were significantly associated with recurrence. Median survival in patients with a ratio (AFP at recurrence divided by AFP 3 months before recurrence) of 0.5 was greater than 70 months, as compared to a median of only 8 months in patients with a ratio of 5.

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“…Age, gender, aetiology of former liver disease, date of liver transplantation, CMV infection status, transaminases, liver synthesis, history of organ rejection and immunosuppressive therapy were raised or withdrawn from clinical charts. As previously described [ 41 ], the Banff schema was used to grade acute cellular rejection in liver biopsies [ 42 ]. Episodes of putative graft complications were primarily defined by biochemical parameters, such as increase in bilirubin, gamma glutamyl transferase (GGT), aspartate (AST) or alanine transferase (ALT).…”

Section: Methodsmentioning

confidence: 99%

Low Serum Levels of (Dihydro-)Ceramides Reflect Liver Graft Dysfunction in a Real-World Cohort of Patients Post Liver Transplantation

Mücke

Gerharz

Jakobi

et al. 2018

IJMS

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Patients after orthopic liver transplantation (OLT) are at risk of developing graft dysfunction. Sphingolipids (SL’s) have been identified to play a pivotal role in the regulation of hepatocellular apoptosis, inflammation and immunity. We aimed to investigate the serum SL profile in a prospective real-world cohort of post-OLT patients. From October 2015 until July 2016, 149 well-characterized post-OLT patients were analyzed. SL’s were assessed in serum probes via Liquid Chromatography/Tandem Mass Spectrometry. Twenty-nine (20%) patients had a biopsy proven graft rejection with decreased C20-ceramide (Cer) (p = 0.042), C18-dihydroceramide (DHC) (p = 0.022) and C24DHC (p = 0.060) levels. Furthermore, C18DHC (p = 0.044) and C24DHC (p = 0.011) were significantly down-regulated in patients with ischemic type biliary lesions (ITBL; n = 15; 10%). One-hundred and thirty-three patients (89%) have so far received tacrolimus as the main immunosuppressive agent with observed elevations of C14Cer (p = 0.052), C18Cer (p = 0.049) and C18:1Cer (p = 0.024). Hepatocellular carcinoma (HCC) pre-OLT was associated with increases in C24:1Cer (p = 0.024) and C24:1DHC (p = 0.024). In this large prospective cross-sectional study of patients, post-OLT serum levels of (very-)long chain (dihydro-)ceramides associate with graft rejection, ITBL, tacrolimus intake and HCC pre-OLT. Hence, serum SL’s may be indicative of graft complications. Further research is necessary to identify their diverse mechanistic role in regulating immunity and inflammation in patients post-OLT.

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Conversion From Sirolimus to Everolimus in Long-Term Liver Graft Recipients

Cited by 7 publications

References 50 publications

Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

Colonization with multidrug-resistant organisms is associated with in increased mortality in liver transplant candidates

AFP ratio predicts HCC recurrence after liver transplantation

Low Serum Levels of (Dihydro-)Ceramides Reflect Liver Graft Dysfunction in a Real-World Cohort of Patients Post Liver Transplantation

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