Schnitzbauer, Andreas A. and Doenecke, Axel and Sothmann, Johannes L. and Loss, Martin and Farkas, Stefan A. and Hartl, Janine and Tsui, Tung-Yu and Baier, Lucia and Kirchner, Gabriele and Obed, Aiman and Bein, Thomas and Geissler, Edward K. and Scherer, Marcus N. and Schlitt, Hans J. (2010) Improved Outcome after 'Bottom-Up' Immunosuppression in Liver Transplant Recipients with Preoperative Renal Impairment. EUROPEAN SURGICAL RESEARCH, 45 (3-4). pp. 356-367. ISSN 0014-312X,
Full text not available from this repository. (Request a copy)Abstract
Background: Most patients with high MELD scores have impaired renal function prior to transplantation. Patient and Methods: A retrospective case control study was conducted with initial low immunosuppression, which was increased when patients rejected or were clinically stable beyond day 30 ('bottom-up'). Results: Thirty patients with impaired renal function were included. Fifteen were treated with de novo cyclosporine A (CsA; group A), and 15 had 'bottom-up' immunosuppression (group B). Baseline renal function was similar: serum creatinine (SCr) median 1.8 mg/dl (range: 1.5-4.0 mg/dl; group A) versus 2.4 mg/dl (range: 1.5-4.0 mg/dl; group B; p = 0.24). The requirement for renal replacement therapy was significantly lower in group B (p = 0.032). Ten received 'bottom-up' immunosuppression [4 CsA/1 sirolimus (Sir) 'on demand' after rejection, 5 Sir (stable)] beyond day 30. By months 6 and 12 (1.6 mg/dl vs. 1.2 mg/dl), SCr values were significantly better in group B (p = 0.006). Renal function in group B did not differ between patients receiving CsA or Sir. Overall complication rates, survival and biopsy-proven acute rejection were similar, although BANFF scores were higher in group B (p = 0.004). Conclusion: Successful implementation of 'bottom-up' immunosuppression in liver transplant recipients with high lab-MELD scores and renal dysfunction at the time of transplantation has the potential to substantially improve short- and long-term outcomes. Copyright (C) 2010 S. Karger AG, Basel
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | DOSE CALCINEURIN INHIBITOR; COMBINED MYCOPHENOLATE-MOFETIL; SOLID-ORGAN TRANSPLANTATION; RISK-FACTORS; INFECTIOUS COMPLICATIONS; INDUCTION-THERAPY; CLINICAL-TRIAL; DYSFUNCTION; FAILURE; CONVERSION; Clinical immunosuppression; Cyclosporine A; 'Bottom-up' immunosuppression; Renal impairment; Liver transplantation; mTOR inhibitor |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 17 Aug 2020 06:56 |
| Last Modified: | 17 Aug 2020 06:56 |
| URI: | https://pred.uni-regensburg.de/id/eprint/25450 |
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