BACKGROUND: Reducing immunosuppression not only reduces complications but also may lessen recurrent hepatitis C virus (HCV) infection after liver transplantation. PATIENTS/ METHODS: HCV-infected cirrhotic patients randomised to tacrolimus monotherapy (MT) or triple therapy (TT) using tacrolimus 0.1 mg/kg/day, azathioprine 1 mg/kg/day, and prednisolone 20 mg/day, tapering over 3 months. RESULTS:Twenty-seven patients (MT) and 29 (TT)--median follow up 661 days (range, 1-1603). Rejection episodes (protocol/further biopsies) within first 3 months and use of empirical treatment were evaluated. New rejection was diagnosed if repeat biopsy (5-day interval) did not show improvement. Treated rejection episodes: 20 MT (15 biopsy-proven) vs. 24 TT (21 biopsy-proven), with 19 (MT) vs. 24 (TT) methylprednisolone boluses. Overall: 35 episodes (MT) and 46 (TT). Fewer MT patients had histological rejection (70%) than TT patients (86%), with fewer episodes of rejection (18.5% vs. 10%), and more moderate rejection (22% vs. 41%). The MT group had higher early tacrolimus levels. Rates of renal dysfunction, retransplantation, and death were not significantly different. CONCLUSION:Tacrolimus monotherapy is a viable immunosuppressive strategy in HCV-infected liver transplant recipients.
RCT Entities:
BACKGROUND: Reducing immunosuppression not only reduces complications but also may lessen recurrent hepatitis C virus (HCV) infection after liver transplantation. PATIENTS/ METHODS:HCV-infected cirrhoticpatients randomised to tacrolimus monotherapy (MT) or triple therapy (TT) using tacrolimus 0.1 mg/kg/day, azathioprine 1 mg/kg/day, and prednisolone 20 mg/day, tapering over 3 months. RESULTS: Twenty-seven patients (MT) and 29 (TT)--median follow up 661 days (range, 1-1603). Rejection episodes (protocol/further biopsies) within first 3 months and use of empirical treatment were evaluated. New rejection was diagnosed if repeat biopsy (5-day interval) did not show improvement. Treated rejection episodes: 20 MT (15 biopsy-proven) vs. 24 TT (21 biopsy-proven), with 19 (MT) vs. 24 (TT) methylprednisolone boluses. Overall: 35 episodes (MT) and 46 (TT). Fewer MT patients had histological rejection (70%) than TT patients (86%), with fewer episodes of rejection (18.5% vs. 10%), and more moderate rejection (22% vs. 41%). The MT group had higher early tacrolimus levels. Rates of renal dysfunction, retransplantation, and death were not significantly different. CONCLUSION:Tacrolimus monotherapy is a viable immunosuppressive strategy in HCV-infected liver transplant recipients.
Authors: Khurram Bari; Shimul A Shah; Tiffany E Kaiser; Robert M Cohen; Nadeem Anwar; David Kleesattel; Kenneth E Sherman Journal: Liver Transpl Date: 2020-08-19 Impact factor: 5.799
Authors: Tommaso Maria Manzia; Roberta Angelico; Paolo Ciano; Jon Mugweru; Kofi Owusu; Daniele Sforza; Luca Toti; Giuseppe Tisone Journal: World J Gastroenterol Date: 2014-09-14 Impact factor: 5.742
Authors: Manuel Rodríguez-Perálvarez; Marta Guerrero-Misas; Douglas Thorburn; Brian R Davidson; Emmanuel Tsochatzis; Kurinchi Selvan Gurusamy Journal: Cochrane Database Syst Rev Date: 2017-03-31
Authors: Jinyang Gu; Xingyu Wu; Lei Lu; Shu Zhang; Jianling Bai; Jun Wang; Jun Li; Yitao Ding Journal: Hepatol Int Date: 2014-03-20 Impact factor: 6.047
Authors: Pinelopi Manousou; Evangelos Cholongitas; Dimitrios Samonakis; Emmanuel Tsochatzis; Alice Corbani; A P Dhillon; Janice Davidson; Manuel Rodríguez-Perálvarez; D Patch; J O'Beirne; D Thorburn; Tuvinh Luong; K Rolles; Brian Davidson; P A McCormick; Peter Hayes; Andrew K Burroughs Journal: Gut Date: 2013-10-16 Impact factor: 23.059