Aim: We designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio versus standard-dose Tac after liver transplantation (LT). Methods: Seventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from postoperative day 1 (EVR group) were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite. Results: Baseline characteristics for the two groups were comparable. The overall patient and graft survival rates were similar (P =.908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in two cases (2.8%), whereas chronic rejection occurred in one (1.4%). The EVR group experienced a better renal function already after 2 weeks (estimated glomerular filtration rate: 89.85 [36.46 to 115.3] mL/min/1.73 m2 vs. 68.77 [16.11 to 115.42] mL/min/1.73 m2; P =.013), which was also observed after a median time of 27 months (range, 0 to 82 months) from LT (estimated glomerular filtration rate: 80 [45 to 118.3] mL/min/1.73 m2 vs. 70.9 [45 to 88.4] mL/min/1.73 m2; P =.04). After a median time of 27 months, the EVR group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus. Conclusion: Ab initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk for post-LT renal impairment.

Manzia, T.m., Angelico, R., Toti, L., Grimaldi, C., Sforza, D., Vella, I., et al. (2018). Ab initio Everolimus-based Versus Standard Calcineurin Inhibitor Immunosuppression Regimen in Liver Transplant Recipients. TRANSPLANTATION PROCEEDINGS, 50(1), 175-183 [10.1016/j.transproceed.2017.12.018].

Ab initio Everolimus-based Versus Standard Calcineurin Inhibitor Immunosuppression Regimen in Liver Transplant Recipients

Manzia, T. M.
;
Angelico, R.;Toti, L.;Sforza, D.;Tariciotti, L.;Lenci, I.;Baiocchi, L.;Tisone, G.
2018-01-01

Abstract

Aim: We designed a retrospective case-control study to determine the efficacy and feasibility of everolimus (EVR) combined with low-dose tacrolimus (Tac) ab initio versus standard-dose Tac after liver transplantation (LT). Methods: Seventy-one adult LT patients, receiving EVR and low-dose Tac without corticosteroids or induction therapy from postoperative day 1 (EVR group) were compared with a well-matched control group of 61 recipients treated with standard-dose Tac in association with antimetabolite. Results: Baseline characteristics for the two groups were comparable. The overall patient and graft survival rates were similar (P =.908). Liver function was stable during the follow-up. In the EVR group, biopsy-proven acute rejection occurred in two cases (2.8%), whereas chronic rejection occurred in one (1.4%). The EVR group experienced a better renal function already after 2 weeks (estimated glomerular filtration rate: 89.85 [36.46 to 115.3] mL/min/1.73 m2 vs. 68.77 [16.11 to 115.42] mL/min/1.73 m2; P =.013), which was also observed after a median time of 27 months (range, 0 to 82 months) from LT (estimated glomerular filtration rate: 80 [45 to 118.3] mL/min/1.73 m2 vs. 70.9 [45 to 88.4] mL/min/1.73 m2; P =.04). After a median time of 27 months, the EVR group showed lower incidence of arterial hypertension and insulin-dependent diabetes mellitus. Conclusion: Ab initio EVR-based immunosuppression could be a valid option immediately after surgery in recipients at high-risk for post-LT renal impairment.
2018
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MED/18 - CHIRURGIA GENERALE
English
Adult; Aged; Biopsy; Calcineurin Inhibitors; Case-Control Studies; Diabetes Mellitus; Drug Therapy, Combination; Everolimus; Feasibility Studies; Female; Glomerular Filtration Rate; Graft Rejection; Graft Survival; Humans; Hypertension; Immunosuppression; Immunosuppressive Agents; Incidence; Liver Transplantation; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Tacrolimus; Time Factors; Surgery; Transplantation
www.elsevier.com/locate/transproceed
Manzia, T.m., Angelico, R., Toti, L., Grimaldi, C., Sforza, D., Vella, I., et al. (2018). Ab initio Everolimus-based Versus Standard Calcineurin Inhibitor Immunosuppression Regimen in Liver Transplant Recipients. TRANSPLANTATION PROCEEDINGS, 50(1), 175-183 [10.1016/j.transproceed.2017.12.018].
Manzia, Tm; Angelico, R; Toti, L; Grimaldi, C; Sforza, D; Vella, I; Tariciotti, L; Lenci, I; Breshanaj, G; Baiocchi, L; Tisone, G
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/209046
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