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Long‐term renal function in liver transplant recipients and impact of immunosuppressive regimens (calcineurin inhibitors alone or in combination with mycophenolate mofetil): The TRY study
Author(s) -
KarieGuigues Svetlana,
Janus Nicolas,
Saliba Faouzi,
Dumortier Jerome,
Duvoux Christophe,
Calmus Yvon,
Lorho Richard,
Deray Gilbert,
LaunayVacher Vincent,
Pageaux GeorgesPhilippe
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21803
Subject(s) - medicine , calcineurin , mycophenolate , renal transplant , liver transplantation , tacrolimus , urology , renal function , mycophenolic acid , pharmacology , transplantation
Abstract The prevalence of renal insufficiency before and at 1, 12, and 60 months after liver transplantation (LTx; primary endpoint) and the changes in the glomerular filtration rate (GFR) at same time points according to the immunosuppressive regimen (coprimary endpoint) were investigated. The primary outcome was determined for the entire cohort, whereas the coprimary endpoint was determined only for 2 groups of patients: those who started and remained on a calcineurin inhibitor (CNI) alone, that is, the CNI‐alone group (n = 624), and those who started and remained on a CNI in combination with mycophenolate mofetil (MMF), that is, the MMF group (n = 117). GFR was <60 mL/minute/1.73 kg/m 2 in 11%, 48%, 51% and 58% of the patients at baseline and at 1, 12, and 60 months, respectively. The decrease in GFR was significantly lower in the MMF group compared to the CNI‐alone group at 12 and 60 months (−16% versus −30% and −15% versus −33%, respectively), whereas the GFR decrease at 1 month was not different between the 2 groups. There were no significant differences between the 2 groups in CNI doses or blood levels at 12 and 60 months. In conclusion, there was a worsening of renal failure in 83% of patients post‐LTx; 58% and 5% had GFRs of <60 and <30 mL/minute/1.73 kg/m 2 , respectively, at 5 years after LTx. The reduction of the GFR was significantly less marked in the MMF group compared to the CNI‐alone agroup, and this could be related to less important CNI exposure early after LTx. It seems likely that early intervention for CNI reduction is best for reducing the use of CNIs in the long term. Liver Transpl 15:1083–1091, 2009. © 2009 AASLD.