Early tacrolimus exposure after liver transplantation: Relationship with moderate/severe acute rejection and long-term outcome

Rodríguez‐Perálvarez, Manuel; Germani, Giacomo; Papastergiou, Vasilios; Tsochatzis, Emmanuel; Thalassinos, Evangelos; Luong, Tu Vinh; Rolando, Nancy; Dhillon, Amar P.; Patch, David; O’Beirne, James; Thorburn, Douglas; Burroughs, Andrew K.

doi:10.1016/j.jhep.2012.09.019

Cited by 100 publications

(93 citation statements)

References 30 publications

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“…In the meantime, large fluctuations in tacrolimus levels, with high levels of exposure early after liver transplant, should be avoided because they increase mortality due to overimmunosuppressionrelated events, such as infections, cardiovascular events (CVEs), and malignancies. 117 …”

Section: Strategies For Managing Nonadherencementioning

confidence: 99%

“…158 If tacrolimus levels are elevated and graft dysfunction progresses, the risk of high levels of exposure becomes too great, thus increasing mortality due to overimmunosuppression-related events. 117 As a general recommendation, tacrolimus dosage modifications should be carried out progressively and with special caution in patients with liver dysfunction. …”

Section: Highly Modifiable Contributors To Variabilitymentioning

confidence: 99%

“…166 This immune unresponsiveness has led to some liver transplant recipients being managed on minimal immunosuppressive regimens with CNIs. 116 Although tolerance can evolve after organ transplantation, in most patients, underexposure of immunosuppression is linked to reduced graft survival and poor patient outcomes in both kidney and liver transplantation, 117,167 so clinicians must be aware of the factors that can lead to suboptimal immunosuppression.…”

Section: Underimmunosuppression After Kidney and Liver Transplantatiomentioning

confidence: 99%

“…158 Tacrolimus trough concentrations less than 7 ng/mL in the first week after liver transplantation is associated with higher rates of moderate/severe rejection compared with levels greater than 7 ng/mL. 117 In the first year after liver transplant, underimmunosuppression (tacrolimus levels <3 ng/mL a or cyclosporine levels <75 ng/mL) is associated with an increase in de novo DSA formation. 39 However, in liver allografts (and in contrast to kidney transplants), early acute cellular rejection does not appear to be associated with worse graft outcomes.…”

Section: Evidence For Cni-minimization Strategiesmentioning

confidence: 99%

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Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

et al. 2017

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Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes. COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant. The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting. 12 Department of Gastroenterology and Hepatology, Erasmus MC, University Hospital Rotterdam, the Netherlands. 13 Department of Gastroenterology and Hepatology, University Hospitals KU Leuven, Belgium.14 Abdominal Transplant Surgery, Microbiology and Immunology Department, University Hospitals KU Leuven, Belgium. 15 Department of Hepatology and Liver Transplantation, Reina Sofía University Hospital, IMIBIC, CIBERehd, Spain. www.transplantjournal.com S1 S olid organ transplantation has evolved from an experimental procedure to an established treatment option for many types of end-stage organ failure. Both patient and graft outcomes are continuing to improve, and 1-year patient and graft survival currently exceed 80%.1,2 However, survival rates gradually decline over the long term. In kidney transplant, 5-and 10-year graft survival rates in Europe are 77% and 56%, and for liver transplant, 64% and 54% (Figures 1 and 2). 3,4 Although most European countries have seen an increase in both living and deceased donation, transplantation is not available to all who would benefit from the procedure, and there is considerable morbidity and mortality for those listed for transplant.6 Therefore, maximizing long-term graft survival and reducing the need for retransplantation is paramount, not only in improving outcomes for the recipients but also for those awaiting a graft. The improvement in outcomes is predominantly due to reduction in (Transplantation. 2017;101:S1-S41). The authors were approached by Astellas to discuss the practical implementation o...

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Section: Strategies For Managing Nonadherencementioning

confidence: 99%

Section: Highly Modifiable Contributors To Variabilitymentioning

confidence: 99%

Section: Underimmunosuppression After Kidney and Liver Transplantatiomentioning

confidence: 99%

Section: Evidence For Cni-minimization Strategiesmentioning

confidence: 99%

See 2 more Smart Citations

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

et al. 2017

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“…A number of retrospective studies have demonstrated a dose related association between CNI IS and HCC recurrence after liver transplant (16,27,43). In the first year after liver transplant it has been shown that the dose of cyclosporin influences HCC recurrence (35).…”

Section: Calcineurin Inhibitors (Cnis)mentioning

confidence: 99%

Optimization of immunosuppressive medication upon liver transplantation against HCC recurrence

Khorsandi¹,

Heaton²

2016

Transl. Gastroenterol. Hepatol.

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Skin Cancer in the Immunocompromised Patient

Harwood

McGregor

Proby³

2016

Rook's Textbook of Dermatology, Ninth Edition

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The immune system plays a critical role in skin cancer development, progression and destruction. Skin cancers in individuals with compromised immune systems represent a growing challenge in terms of their frequency and diversity as well as their atypical and often aggressive nature. Mortality and morbidity associated with skin tumours in this clinical context are often considerable, their pathogenesis is multifactorial and an evidence base to guide management is lacking in many key areas.

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Early tacrolimus exposure after liver transplantation: Relationship with moderate/severe acute rejection and long-term outcome

Cited by 100 publications

References 30 publications

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients

Optimization of immunosuppressive medication upon liver transplantation against HCC recurrence

Skin Cancer in the Immunocompromised Patient

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