Tacrolimus dosage requirements in living donor liver transplant recipients with small-for-size grafts

Liu, Fei; Li, Ya; Xiang, Lan; Yue, Wei; Li, Bo; Yan, Lvnan; Wen, Tianfu; Zhao, Jichun; Xu, Mingqing; Wang, Wentao; Yang, Jiayin

doi:10.3748/wjg.15.3931

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…All the transplant patients were treated with tacrolimus and steroids for immuno suppression [25]. Steroids are known inducers of liver enzyme activities, although effect of tacrolimus on serum enzymes is unknown.…”

Section: Discussionmentioning

confidence: 99%

A Single Centre Prospective Study of Liver Function Tests in Post Liver Transplant Patients

et al. 2012

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Liver transplantation means surgical replacement of a diseased liver with a healthy liver. The survival rate used to be 30 % after 1 year and LTx was considered to be the last procedure when all medical or surgical intervention failed. Advances in donor organ preservation, surgical techniques, patient selection, immunosuppressive regimens and treatments for opportunistic infections all have contributed to substantially improve the survival rates. Despite substantial technological, medical and surgical advances, liver transplantation remains a complex procedure that is accompanied by significant morbidity and mortality. The post-operative outcome of each patient varies greatly depending on the patient's pre-operative state, quality of the donated organ and the complexity of the surgery. Complications occur both immediately post transplant and in the long term. Most of the problems can be satisfactorily assessed with a panel of routine LFTs results of which are generated quickly, cheaply on the analyzer which operates 24 h. Liver Function Test identifies the presence of problem but not problem itself. Abnormal results can be meaningful only when used with clinical data, radiological findings. The study includes 75 post LTx patients in three groups adults (non ACR), Pediatrics and ACR. All recipients were on immunosuppressive therapy (tacrolimus, mycophenolate and methylprednisolone), antiviral (ganciclovir), antiprotozoal, antibacterial and antifungal (fluconazole). 5 mL of blood was drawn in plain vacutainer from the post LTx patients every day for 15 days and LFT and GGT was done. Routinely performed liver function tests correlates well with clinical complications involving liver in the transplant patients. Instead of daily testing, may be alternate day analysis of LFT should be sufficient for effective monitoring of patients. The total protein and albumin and the transaminases offer little help in monitoring LFT post LTx. The elevated levels of serum GGT and ALP may be related to chronic immune damage to the transplanted liver. Serum GGT and ALP can be used as early markers for diagnosing biliary complications and can be used to asses adequacy of endoscopic treatment in the group of patients presenting early. Thus, most of the problems can be satisfactorily assed with a panel of routine LFTs generated quickly, cheaply on analyzer which operates 24 h each day. However, it must be emphasized that LFTs may identify the presence of problems but not the problem itself and the abnormal results are meaningful only when correlated with other clinical information.

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Section: Discussionmentioning

confidence: 99%

A Single Centre Prospective Study of Liver Function Tests in Post Liver Transplant Patients

et al. 2012

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“…The selection criteria for the donor and recipient as well as surgical techniques for both donor and recipient operations have been described in detail elsewhere [23] , [24] . A detail description of the immunosuppression regimen was described in previous investigation [25] . All patients were followed after surgery by our surgical team, with CT scans of the chest and abdomen every 3 months for the first 2 years and every 6 months thereafter.…”

Section: Methodsmentioning

confidence: 99%

Salvage Liver Transplantation for Recurrent Hepatocellular Carcinoma within UCSF Criteria after Liver Resection

et al. 2012

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BackgroundSalvage liver transplantation (SLT) is restricted to patients who develop hepatocellular carcinoma (HCC) recurrence within Milan criteria (MC). Little is known about outcomes for SLT in patients with recurrent HCC within University of California San Francisco (UCSF) criteria after liver resection (LR).MethodsBetween January 2001 and December 2011, 380 patients with HCC meeting UCSF criteria, 200 of which were resected (LR group) from a perspective of SLT in case of recurrence, and 180 directly underwent LT (PLT). We compared patient characteristics, perioperative and long-term outcomes between SLT and PLT groups. We also assessed the outcome of LR and PLT groups.ResultsAmong the 200 patients in LR group, 86 (43%) developed HCC recurrence and 15/86 (17%) of these patients presented HCC recurrence outside UCSF criteria. Only 39 of the 86 patients underwent SLT, a transplantation rate of 45% of patients with HCC recurrence. Compared with PLT group, LR group showed lower overall survival rate (P = 0.005) and higher recurrence rate (P = 0.006). Although intraoperative blood loss and required blood transfusion were more frequent in SLT group, the perioperative mortality and posttransplant complications were similar in SLT and PLT groups. The overall survival and recurrence rates did not significantly differ between the two groups. When stratifying by graft type in the SLT group, overall survival and recurrence rates did not significantly differ between deceased donor LT (DDLT) and living donor LT (LDLT) groups. In the subgroup analysis by MC, similar results were observed between patients with recurrent HCC meeting MC and patients with recurrent HCC beyond MC but within UCSF criteria.ConclusionOur single institution experience demonstrated that prior hepatectomy and SLT for recurrent HCC within UCSF criteria was feasible and SLT could achieve the same outcome as PLT.

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“…Hence TAC clearance may change as the graft regenerates and changes in size after transplantation. 5,6 Several studies 5,6 have shown that the TAC dose requirement, which indirectly reflects TAC metabolism by the liver, increases gradually after LT as the new liver regenerates and liver function normalizes. The TAC concentration-dose ratio (CD ratio), estimated by dividing the TAC trough concentration (ng/mL) by the corresponding daily TAC dose (mg/day or mg/kg/day), has also been used to estimate TAC pharmacokinetics in several studies.…”

Section: Introductionmentioning

confidence: 99%

Graft-to-Recipient Weight Ratio Associated With Tacrolimus Metabolism Following Pediatric Living Donor Liver Transplantations

Shoji¹,

Miyairi²,

Inoue³

et al. 2019

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES Tacrolimus (TAC) is an important immunosuppressant in liver transplantation. Since TAC is mainly metabolized by the liver enzymes CYP3A4 and 5, liver function is crucial for its pharmacokinetics (PK). Liver function is dynamic after liver transplantation; hence the PK of TAC metabolism after pediatric liver transplantation is not well understood. We aimed to investigate the time-dependent changes in TAC metabolism and to find factors influencing TAC PK after pediatric liver transplantation. METHODS We retrospectively reviewed the characteristics of the donors and recipients in pediatric living donor liver transplantation and used the TAC concentration-dose (CD) ratio as a surrogate marker of TAC metabolism. RESULTS Included were 326 patients with a median age of 13 months. After the liver transplantation, the CD ratio gradually decreased, then plateaued around day 21 to 28. A linear regression analysis demonstrated that a lower graft-to-recipient weight ratio (GRWR) and higher prothrombin time–international normalized ratio (PT-INR) were independently associated with a higher CD ratio in the early period after liver transplantation. However, association between GRWR and TAC CD ratio disappeared around 6 to 12 months after a liver transplantation possibly owing to graft regeneration. CONCLUSIONS Tacrolimus metabolism improved within the first month after liver transplantation, and the small graft size was associated with lower TAC metabolism in the early period after pediatric living donor liver transplantation.

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Tacrolimus dosage requirements in living donor liver transplant recipients with small-for-size grafts

Cited by 8 publications

References 23 publications

A Single Centre Prospective Study of Liver Function Tests in Post Liver Transplant Patients

A Single Centre Prospective Study of Liver Function Tests in Post Liver Transplant Patients

Salvage Liver Transplantation for Recurrent Hepatocellular Carcinoma within UCSF Criteria after Liver Resection

Graft-to-Recipient Weight Ratio Associated With Tacrolimus Metabolism Following Pediatric Living Donor Liver Transplantations

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