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