Open AccessDaclizumab induction and maintenance steroid‐free immunosuppression with mycophenolate mofetil and tacrolimus to prevent acute rejection of hepatic allografts
Author(s) -
Figueras Joan,
Prieto Martin,
Bernardos Angel,
Rimola Antoni,
Suárez Francisco,
De Urbina Jorge Ortiz,
CuervasMons Valentín,
Mata Manuel de la
Publication year - 2006
Publication title -
transplant international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.998
H-Index - 82
eISSN - 1432-2277
pISSN - 0934-0874
DOI - 10.1111/j.1432-2277.2006.00326.x
Subject(s) - daclizumab , medicine , tacrolimus , immunosuppression , gastroenterology , regimen , liver transplantation , transplantation , methylprednisolone , mycophenolate , mycophenolic acid , thymoglobulin , surgery
Summary Steroid‐free immunosuppressive regimens reduce corticosteroid‐related side effects in liver transplant recipients although their efficacy is very variable. We evaluated the efficacy and safety of a steroid‐free regimen in a 6‐month, open‐label, multicenter, pilot study, which involved 102 liver transplant patients treated with daclizumab (2 mg/kg within 6 h following transplant and 1 mg/kg on day 7), mycophenolate mofetil (MMF, 1 g b.i.d) and tacrolimus (trough levels of 5–15 ng/ml in the first month and 5–10 ng/ml thereafter). One intra‐operative dose of methylprednisolone was administered. At 6 months, the acute rejection rate was 9.8%, and patient and graft survival rates were 96% and 95%, respectively. Acute rejection rates were similar for hepatitis C‐positive patients (8.6%) and hepatitis C‐negative patients (10.4%). Infections occurred in 22% of patients; most cases were considered mild or moderate. Post‐transplantation hypertension and diabetes mellitus developed in 37% and 14% of patients, respectively, during the study period, but were markedly less frequent (8% and 6%, respectively) at 6 months. Hypercholesterolemia was observed in only 2% of patients. In conclusion, the steroid‐free immunosuppressive regimen of daclizumab, MMF, and tacrolimus effectively prevents acute rejection after liver transplantation without decreasing safety.