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Transplantation. 2010 Jun 27;89(12):1504-10. doi: 10.1097/TP.0b013e3181db8cf0.

Assessing renal function with daclizumab induction and delayed tacrolimus introduction in liver transplant recipients.

Author information

1
Unité de Transplantation Hépatique, Hôpital Saint-Antoine, Paris, France. yvon.calmus@sat.aphp.fr

Abstract

BACKGROUND:

Calcineurin inhibitor-induced renal dysfunction is a major problem in liver transplantation. Interleukin-2 receptor antagonist induction followed by delayed tacrolimus (Tac) administration may minimize the renal insult without compromising immunoprotection.

METHODS:

This open, randomized, multicenter trial evaluated the benefit of daclizumab induction with delayed Tac on renal function at 6 months; an observational study was continued for 18 months. Liver transplant patients with a 12-hr serum creatinine (SrC) level less than 180 micromol/L received either delayed Tac with daclizumab induction (n=98) or standard Tac (n=101) both combined with mycophenolate mofetil and steroids. The primary endpoint was the incidence of SrC level more than 130 micrommol/L at 6 months.

RESULTS:

The incidence was 22.4% with delayed Tac and 29.7% with standard Tac (P=ns), which remained unchanged at 12 months (21.6% and 23.9%) but increasing slightly at 24 months (29.0% and 32.9%), respectively. A post hoc analysis of renal function was done based on patients stratification by SrC at 12 hr (<or=100micromol/L or >100 micromol/L) showing no difference in SrC values at 6 months regardless of the 12-hr values despite a trend toward better estimated glomerular filtration rate for patients with 12-hr value less than 100 micromol/L in the delayed Tac group. Biopsy-proven acute rejection was similar at 6 months (17.5% and 18.75%), 12 months (23.5% and 23.8%), and 24 months (24.5% and 25.7%), respectively. Patient and graft survival in both groups were comparable and good. Similar types and incidences of adverse events were reported in both groups at all time.

CONCLUSIONS:

Delay of Tac does not benefit renal function in liver transplant recipients with a good renal function at baseline.

PMID:
20495510
DOI:
10.1097/TP.0b013e3181db8cf0
[Indexed for MEDLINE]
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