02 May 2017 : Original article
Real-World Multicenter Experience of Immunosuppression Minimization Among 661 Liver Transplant RecipientsDiego Aguiar1BC, Diego Martínez-Urbistondo1BC, Alberto Baroja-Mazo23B, Manuel de la Mata245B, Manuel Rodríguez-Perálvarez245B, Angel Rubín26B, Lorena Puchades6B, Trinidad Serrano7B, Jessica Montero7B, Antonio Cuadrado8B, Fernando Casafont9B, Magdalena Salcedo210B, Diego Rincón10B, Jose A. Pons2311ABDFG, Jose I. Herrero1212ABCDEFG*
Ann Transplant 2017; 22:265-275
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.
Keywords: Drug-Related Side Effects and Adverse Reactions, Liver Transplantation, Transplantation Tolerance
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