Safety of Tacrolimus Monotherapy within 12 Months after Liver Transplantation in the Era of Reduced Tacrolimus and Mycophenolate Mofetil: National Registry Study

Journal of Clinical Medicine

KOTRY Study Group¹  Sung Hwa Kim²  Bong-Wan Kim³  Shin Hwang⁴  Donglak Choi⁵  Young Kyoung You⁶  Tae-Seok Kim⁷  Geun Hong⁸  Dong-Sik Kim⁹  Je Ho Ryu^1,10  Jong Man Kim^1,11  Jai Young Cho^1,12  Suk Kyun Hong^1,13  Yang Won Nah^1,14  Jae Geun Lee^1,15  Myoung Soo Kim^1,15  Deok Gie Kim^1,15  Dong Jin Joo^1,15 

[1] ;Department of Biostatistics, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;Department of Liver Transplantation and Hepatobiliary Surgery, Ajou University School of Medicine, Suwon 16499, Korea;Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea;Department of Surgery, Catholic University of Daegu, Daegu 42472, Korea;Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul 06591, Korea;Department of Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu 42601, Korea;Department of Surgery, EWHA Womans University College of Medicine, Seoul 07804, Korea;Department of Surgery, Korea University College of Medicine, Seoul 02841, Korea;Department of Surgery, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Busan 49241, Korea;Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06531, Korea;Department of Surgery, Seoul National University College of Medicine, Bundang Hospital, Seongnam 13620, Korea;Department of Surgery, Seoul National University College of Medicine, Seoul 03080, Korea;Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, Korea;Department of Surgery, Yonsei University College of Medicine, Seoul 03722, Korea;

关键词: liver transplantation;    tacrolimus;    mycophenolate mofetil;    renal dysfunction;    time-conditional propensity score;   

DOI  :  10.3390/jcm11102806

来源: DOAJ

【 摘 要 】

Tacrolimus monotherapy is accepted as a feasible option during early post-liver transplantation as per current international consensus guidelines. However, its effects in the recent era of reduced tacrolimus (TAC) and mycophenolate mofetil (MMF) remain unclear. Liver recipients who either received TAC monotherapy from the treatment onset or switched from TAC/MMF to TAC-mono within 12 months (TAC-mono group; n = 991) were chronologically matched to patients who continued to receive TAC/MMF (TAC/MMF group; n = 991) at the corresponding time points on time-conditional propensity scores. Outcomes within 12 months after matched time points were compared. Biopsy-proven rejection (TAC/MMF: 3.5% vs. TAC-mono: 2.6%; p = 0.381) and graft failure (0.2% vs. 0.7%; p = 0.082) were similar in both groups. However, the decline in eGFR was 3.1 mL/min/1.73 m² (95% CI: 0.8–5.3) greater at six months (p = 0.008) and 2.4 mL/min/1.73 m² (95% CI: −0.05–4.9) greater at 12 months (p = 0.048) after the matched time points in TAC-mono group than that in TAC/MMF group. TAC trough levels were also higher in the TAC-mono group throughout the study period. TAC-mono within 12 months after liver transplantation is immunologically safe. However, it can increase the required TAC dose and the decline in renal function than that in TAC/MMF combination therapy.

【 授权许可】

Unknown