Basiliximab With Delayed Tacrolimus Improves Short-Term Renal Outcomes Post-Liver Transplantation-a Real-World Experience.
Acute Kidney Injury
/ epidemiology
Adrenal Cortex Hormones
/ administration & dosage
Adult
Basiliximab
/ administration & dosage
Drug Therapy, Combination
Female
Graft Rejection
/ epidemiology
Graft Survival
/ drug effects
Humans
Immunosuppression Therapy
/ methods
Immunosuppressive Agents
/ administration & dosage
Incidence
Kidney
/ drug effects
Liver Transplantation
/ adverse effects
Male
Middle Aged
Mycophenolic Acid
/ administration & dosage
Postoperative Complications
/ epidemiology
Prospective Studies
Retrospective Studies
Tacrolimus
/ administration & dosage
Treatment Outcome
Journal
Transplantation proceedings
ISSN: 1873-2623
Titre abrégé: Transplant Proc
Pays: United States
ID NLM: 0243532
Informations de publication
Date de publication:
Jun 2021
Jun 2021
Historique:
received:
11
12
2020
revised:
16
03
2021
accepted:
05
04
2021
pubmed:
3
6
2021
medline:
13
7
2021
entrez:
2
6
2021
Statut:
ppublish
Résumé
Acute kidney injury (AKI) is common after liver transplantation (LT). Induction with interleukin-2 receptor antagonists is often used as a "renal-sparing" strategy. The aim of this study was to assess this approach in a real-world setting in an LT center. A retrospective cohort analysis of LTs between 2011 and 2018 was performed to assess the impact of a renal-sparing strategy using basiliximab in conjunction with mycophenolate mofetil and corticosteroids from day 0 post-LT along with delayed introduction of tacrolimus. This was compared with a group receiving tacrolimus, mycophenolate mofetil, and corticosteroids from the outset. The renal-sparing regimen was associated with significantly lower incidence of all-stage AKI at day 7 post-LT (36% vs 55%, P = .006) and less decline in renal function at 3 months (39% vs 57%, P = .01). No further significant differences in renal outcomes were observed at other time points on follow-up to 1 year post-LT. There was no significant difference in the incidence of acute cellular rejection, inpatient length of stay or graft survival. The decision to adopt a renal-sparing regimen was predominantly made on a clinically reactive basis within the first 24 hours post-LT in 77%, and was preordained in 23%. Cost-effectiveness analysis did not find evidence of a significant cost saving when using a renal-sparing strategy. This study provides real-world analysis of the use of a renal-sparing immunosuppression regimen in LT. Although improvements in incidence of AKI in the short term were demonstrated, this did not translate to cost savings or improved renal outcomes after 3 months.
Sections du résumé
BACKGROUND
BACKGROUND
Acute kidney injury (AKI) is common after liver transplantation (LT). Induction with interleukin-2 receptor antagonists is often used as a "renal-sparing" strategy. The aim of this study was to assess this approach in a real-world setting in an LT center.
METHODS
METHODS
A retrospective cohort analysis of LTs between 2011 and 2018 was performed to assess the impact of a renal-sparing strategy using basiliximab in conjunction with mycophenolate mofetil and corticosteroids from day 0 post-LT along with delayed introduction of tacrolimus. This was compared with a group receiving tacrolimus, mycophenolate mofetil, and corticosteroids from the outset.
RESULTS
RESULTS
The renal-sparing regimen was associated with significantly lower incidence of all-stage AKI at day 7 post-LT (36% vs 55%, P = .006) and less decline in renal function at 3 months (39% vs 57%, P = .01). No further significant differences in renal outcomes were observed at other time points on follow-up to 1 year post-LT. There was no significant difference in the incidence of acute cellular rejection, inpatient length of stay or graft survival. The decision to adopt a renal-sparing regimen was predominantly made on a clinically reactive basis within the first 24 hours post-LT in 77%, and was preordained in 23%. Cost-effectiveness analysis did not find evidence of a significant cost saving when using a renal-sparing strategy.
CONCLUSION
CONCLUSIONS
This study provides real-world analysis of the use of a renal-sparing immunosuppression regimen in LT. Although improvements in incidence of AKI in the short term were demonstrated, this did not translate to cost savings or improved renal outcomes after 3 months.
Identifiants
pubmed: 34074467
pii: S0041-1345(21)00249-9
doi: 10.1016/j.transproceed.2021.04.001
pii:
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Immunosuppressive Agents
0
Basiliximab
9927MT646M
Mycophenolic Acid
HU9DX48N0T
Tacrolimus
WM0HAQ4WNM
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1541-1547Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.