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

T M Manzia, R Angelico, L Toti, C Grimaldi, D Sforza, I Vella, L Tariciotti, I Lenci, G Breshanaj, L Baiocchi, G Tisone

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)175-183
Number of pages9
JournalTransplantation Proceedings
Volume50
Issue number1
DOIs
Publication statusPublished - Feb 7 2018

Keywords

  • Adult
  • Aged
  • Biopsy
  • Calcineurin Inhibitors/administration & dosage
  • Case-Control Studies
  • Diabetes Mellitus/epidemiology
  • Drug Therapy, Combination
  • Everolimus/administration & dosage
  • Feasibility Studies
  • Female
  • Glomerular Filtration Rate
  • Graft Rejection/epidemiology
  • Graft Survival/drug effects
  • Humans
  • Hypertension/epidemiology
  • Immunosuppression/methods
  • Immunosuppressive Agents/administration & dosage
  • Incidence
  • Liver Transplantation/methods
  • Male
  • Middle Aged
  • Postoperative Complications/etiology
  • Retrospective Studies
  • Tacrolimus/administration & dosage
  • Time Factors

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