Scientific publications

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

May 2, 2017 | Magazine: Annals of Trasplantation

Diego Aguiar  1 , Diego Martínez-Urbistondo  1 , Alberto Baroja-Mazo  2   3 , Manuel de la Mata  2   4   5 , Manuel Rodríguez-Perálvarez  2   4   5 , Angel Rubín  2   6 , Lorena Puchades  6 , Trinidad Serrano  7 , Jessica Montero  7 , Antonio Cuadrado  8 , Fernando Casafont  9 , Magdalena Salcedo  2   10 , Diego Rincón  10 , Jose A Pons  2   3   11 , Jose I Herrero  1   2   12

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.

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.

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.

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.

CITATION  Ann Transplant. 2017 May 2;22:265-275. doi: 10.12659/aot.902523