Early Conversion to Everolimus Within 180 Days of Living Donor Liver Transplantation

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2024-07-18 DOI:10.1111/ctr.15402

Katelyn N. Rudzik, Kristine S. Schonder, Abhinav Humar, Heather J. Johnson

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Abstract

Background

Early conversion to Everolimus (EVR) post deceased donor liver transplant has been associated with improved renal function but increased rejection. Early EVR conversion has not been evaluated after living donor liver transplant (LDLT). A retrospective cohort study was conducted to compare the rate of rejection and renal function in patients converted to EVR early post-LDLT to patients on calcineurin inhibitors (CNIs).

Methods

This was a single center retrospective cohort study of adult LDLT recipients between January 2012 and July 2019. Patients converted to EVR within 180 days of transplant were compared to patients on CNIs. The primary endpoint was biopsy proven acute rejection (BPAR) at 24 months posttransplant. Key secondary endpoints included eGFR at 24 months, change in eGFR, adverse events, and all-cause mortality.

Results

From a total of 173 patients involved in the study: 58 were included in the EVR group and 115 in the CNI group. Median conversion to EVR was 26 days post-LDLT. At 24 months, there was no difference in BPAR (22.7% EVR vs. 19.1% CNI, p = 0.63). Median eGFR at 24 months posttransplant was not significantly different (68.6 [24.8 to 112.4] mL/min EVR vs. 75.9 [35.6–116.2] mL/min CNI, p = 0.103). Change in eGFR from baseline was worse in the EVR group (−13.0 [−39.9 to 13.9] mL/min EVR vs. −5.0 [−31.2 to 21.2] mL/min CNI, p = 0.047). Median change from conversion to 24 months posttransplant (EVR group only) was −3.43 mL/min/1.73 m² (−21.0 to 9.6).

Conclusions

Early EVR conversion was not associated with increased risk of rejection among LDLT recipients. Renal function was not impacted. EVR may be considered as an alternative after LDLT in patients intolerant of CNIs.

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活体肝移植后 180 天内尽早转用依维莫司。

背景：死亡供体肝移植后早期转用依维莫司（EVR）可改善肾功能，但会增加排斥反应。尚未对活体肝移植（LDLT）后早期转用依维莫司进行评估。我们进行了一项回顾性队列研究，以比较LDLT后早期转为EVR的患者与使用钙神经蛋白抑制剂（CNIs）的患者的排斥反应率和肾功能：这是一项单中心回顾性队列研究，研究对象为2012年1月至2019年7月期间接受LDLT的成人患者。将移植后180天内转为EVR的患者与使用CNIs的患者进行比较。主要终点是移植后24个月活检证实的急性排斥反应（BPAR）。主要次要终点包括24个月时的eGFR、eGFR的变化、不良事件和全因死亡率：共有 173 名患者参与了研究：结果：总共有 173 名患者参与了这项研究：58 人被纳入 EVR 组，115 人被纳入 CNI 组。转为EVR的中位时间为LDLT术后26天。24个月后，BPAR无差异（EVR为22.7%，CNI为19.1%，P = 0.63）。移植后 24 个月的中位 eGFR 无显著差异（EVR 为 68.6 [24.8 至 112.4] mL/min vs CNI 为 75.9 [35.6-116.2] mL/min，p = 0.103）。EVR组的eGFR与基线相比变化较小（-13.0 [-39.9 to 13.9] mL/min EVR vs. -5.0 [-31.2 to 21.2] mL/min CNI，p = 0.047）。从转换到移植后24个月的中位变化（仅EVR组）为-3.43 mL/min/1.73 m2 (-21.0 to 9.6)：结论：早期EVR转换与LDLT受者排斥风险增加无关。结论：早期 EVR 转换与 LDLT 受者排斥风险的增加无关，肾功能也未受到影响。对于不耐受 CNIs 的患者，可考虑在 LDLT 后将 EVR 作为一种替代治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.