ORBi: Neuberger J. M. - Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the 'ReSpECT' study

Reference : Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplanta...


	Document type :	Scientific journals : Article
	Discipline(s) :	Human health sciences : Gastroenterology & hepatology Human health sciences : Surgery
	To cite this reference:	http://hdl.handle.net/2268/5478

Title :	Delayed introduction of reduced-dose tacrolimus, and renal function in liver transplantation: the 'ReSpECT' study
Language :	English
Author, co-author :	Neuberger, J. M. [> >]
	Mamelok, R. D. [> >]
	Neuhaus, P. [> >]
	Pirenne, J. [> >]
	Samuel, D. [> >]
	Isoniemi, H. [> >]
	Rostaing, L. [> >]
	Rimola, A. [> >]
	Marshall, S. [> >]
	Mayer, A. D. [> >]
	Fabregat-Prous, J. [> >]
	Durand, F. [> >]
	Friman, S. [> >]
	Bechstein, W. [> >]
	Schmidt, J. [> >]
	Schemmer, P. [> >]
	Hauss, J. P. [> >]
	Clavien, P. A. [> >]
	Broelsch, C. E. [> >]
	Bernados, A. [> >]
	Detry, Olivier [Centre Hospitalier Universitaire de Liège - CHU > > Chirurgie abdominale- endocrinienne et de transplantation >]
	Bouillot, O. [> >]
	Soderdahl, G. [> >]
	Brekke, I. B. [> >]
	Bentdal, O. [> >]
	Mueller, A. [> >]
	Dreske, B. [> >]
	Colle, I. [> >]
	Cuervas-Mons, V. [> >]
	Salcedo, M. [> >]
	Zuelke, C. [> >]
	Schlitt, H. [> >]
	Suarez, M. F. [> >]
	Patch, D. [> >]
	Declerck, N. [> >]
	Varo, E. [> >]
	Boon, N. [> >]
Publication date :	Feb-2009
Journal title :	American Journal of Transplantation
Publisher :	Blackwell Publishing
Volume :	9
Issue/season :	2
Pages :	327-336
Audience :	International
ISSN :	1600-6135
e-ISSN :	1600-6143
Keywords :	[en] liver Transplantation ; renal insufficiency
Abstract :	[en] We report a multicenter, prospective, randomized, open-label trial investigating the effect of lower levels and delayed introduction of tacrolimus on renal function in liver transplant recipients. Adult patients with good renal function undergoing primary liver transplant were randomized to either: group A (standard-dose tacrolimus [target trough levels >10 ng/mL] and corticosteroids; n = 183); group B (mycophenolate mofetil [MMF] 2g/day, reduced-dose tacrolimus [target trough levels </=8 ng/mL], and corticosteroids; n = 170); group C (daclizumab induction, MMF, reduced-dose tacrolimus delayed until the fifth day posttransplant and corticosteroids, n = 172). The primary endpoint was change from baseline in estimated glomerular filtration rate (eGFR) at 52 weeks. The eGFR decreased by 23.61, 21.22 and 13.63 mL/min in groups A, B and C, respectively (A vs C, p = 0.012; A vs B, p = 0.199). Renal dialysis was required less frequently in group C versus group A (4.2% vs. 9.9%; p = 0.037). Biopsy-proven acute rejection rates were 27.6%, 29.2% and 19.0%, respectively. Patient and graft survival was similar. In conclusion, daclizumab induction, MMF, corticosteroids and delayed reduced-dose tacrolimus was associated with less nephrotoxicity than therapy with standard-dose tacrolimus and corticosteroids without compromising efficacy or tolerability.
Target :	Professionals ; Students ; General public
Permalink :	http://hdl.handle.net/2268/5478

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