Favorable longterm outcomes of liver transplant recipients treated de novo with once‐daily tacrolimus: Results of a single‐center cohort

Abstract

The once-daily prolonged-release formulation of tacrolimus has been recently related with significant graft and patient mid-term survival advantages; however, practical information on the de novo administration after liver transplantation and longterm outcomes is currently lacking. This study is a 5-year retrospective analysis of a single-center cohort of liver transplant recipients treated de novo with once-daily tacrolimus (April 2008/August 2011). The study cohort consisted of 160 patients, including 23 with pretransplant renal dysfunction, with a median follow-up of 57.6 months (interquartile range, 46.6-69.0). Tacrolimus target trough levels were 5-10 ng/mL during the first 3 months after transplant, reducing progressively to <7 ng/mL after the first posttransplant year. Once-daily tacrolimus was withdrawn in 35 (21.8%) patients during follow-up, mostly due to renal dysfunction and/or metabolic syndrome. The biopsy-proven acute rejection rate was 12.5% with no cases of steroid-resistant rejection. The cumulative incidence of de novo diabetes, hypertension, and dyslipidemia were 16.9%, 31.2%, and 6.5%, respectively. Hepatocellular carcinoma recurrence rate was 2.8%. Renal function remained stable after the sixth month after transplant with a mean estimated glomerular filtration rate of 77.7 ± 19.6 mL/minute/1.73 m(2) at 5 years. None of our patients developed chronic kidney disease stage 4 or 5. Patient survival at 1, 3, and 5 years was 96.3%, 91.9%, and 88.3%, respectively. Overall survival of patients with Model for End-Stage Liver Disease (MELD) score > 25 points was not significantly different. In conclusion, our study suggests that immunosuppression based on de novo once-daily tacrolimus is feasible in routine clinical practice, showing favorable outcomes and outstanding longterm survival even in patients with high MELD scores. Liver Transplantation 22 1391-1400 2016 AASLD.

Successful pregnancy outcomes following liver transplantation is predicted by renal function

“…The number of pregnancies in LT recipients has been rising steadily over the last few decades. Pregnancy outcomes in a meta‐analysis and a number of case series, including our own unit, are favorable, but inherent fetal and maternal risks remain . These women will expect and require extensive counseling regarding contraception and pregnancy from their transplant physicians and obstetrics team.…”

“…Pregnancy outcomes in a meta-analysis and a number of case series, including our own unit, are favorable, but inherent fetal and maternal risks remain. (10)(11)(12)(13)(24)(25)(26)(27) These women will expect and require extensive counseling regarding contraception and pregnancy from their transplant physicians and obstetrics team. Interestingly, we show that live birth rates over the last 3 decades have improved significantly, likely reflecting improvements in hepatological and obstetric care.…”

“…For young women, there is an expectation of returning to a normal quality of life after LT, including the ability to have children . Pregnancy outcomes following LT including previous reports from our own center have been shown to be favorable, but with an increased risk of premature birth, intrauterine growth restriction, and graft dysfunction . The dominant prepregnancy advice was to recommend deferral of pregnancy to a time period >1 year following transplant.…”

“…(9) Pregnancy outcomes following LT including previous reports from our own center have been shown to be favorable, but with an increased risk of premature birth, intrauterine growth restriction, and graft dysfunction. (10)(11)(12)(13)(14) The dominant prepregnancy advice was to recommend deferral of pregnancy to a time period >1 year following transplant. However, the influence of biochemical parameters after LT on pregnancy outcomes has not yet been completely evaluated.…”

Short- and Long-term Outcomes of De Novo Liver Transplant Patients Treated With Once-Daily Prolonged-Release Tacrolimus

“…As long as the concentration is well controlled, the immediate start of TAC-PR should be better because of its simplicity and unnecessary conversion of the TAC formula. 17 …”