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Real-World Multicenter Experience of Immunosuppression Minimization Among 661 Liver Transplant Recipients

Diego Aguiar, Diego Martínez-Urbistondo, Alberto Baroja-Mazo, Manuel de la Mata, Manuel Rodríguez-Perálvarez, Angel Rubín, Lorena Puchades, Trinidad Serrano, Jessica Montero, Antonio Cuadrado, Fernando Casafont, Magdalena Salcedo, Diego Rincón, Jose A. Pons, Jose I. Herrero

(Liver Unit, University Clinic of Navarra, Pamplona, Spain)

Ann Transplant 2017; 22:265-275

DOI: 10.12659/AOT.902523


BACKGROUND: Long-term morbidity and mortality in liver transplant recipients is frequently secondary to immunosuppression toxicity. However, data are scarce regarding immunosuppression minimization in clinical practice.
MATERIAL AND METHODS: In this cross-sectional, multicenter study, we reviewed the indications of immunosuppression minimization (defined as tacrolimus levels below 5 ng/mL or cyclosporine levels below 50 ng/mL) among 661 liver transplant recipients, as well as associated factors and the effect on renal function.
RESULTS: Fifty-three percent of the patients received minimized immunosuppression. The median time from transplantation to minimization was 32 months. The most frequent indications were renal insufficiency (49%), cardiovascular risk (19%), de novo malignancy (8%), and cardiovascular disease (7%). The factors associated with minimization were older age at transplantation, longer post-transplant follow-up, pre-transplant diabetes mellitus and renal dysfunction, and the hospital where the patients were being followed. The patients who were minimized because of renal insufficiency had a significant improvement in renal function (decrease of the median serum creatinine level, from 1.50 to 1.34 mg/dL; P=0.004). Renal function significantly improved in patients minimized for other indications, too. In the long term, glomerular filtration rate significantly decreased in non-minimized patients and remained stable in minimized patients.
CONCLUSIONS: Immunosuppression minimization is frequently undertaken in long-term liver transplant recipients, mainly for renal insufficiency. Substantial variability exists regarding the use of IS minimization among centers.

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