AIM: To investigate the incidence and risk factors of late-onset acute rejection (LAR) and to clarify the effectiveness of our immunosuppressive regime consisting of life-long administration of tacrolimus and steroids. METHODS: Adult living donor liver transplantation recipients (n=204) who survived more than 6 mo after living donor liver transplantation were enrolled. Immunosuppression was achieved using tacrolimus and methylprednisolone. When adverse effects of tacrolimus were detected, the patient was switched to cyclosporine. Six months after transplantation, tacrolimus or cyclosporine was carefully maintained at a therapeutic level. The methylprednisolone dosage was maintained at 0.05 mg/kg per day by oral administration. Acute rejections that occurred more than 6 mo after the operation were defined as late-onset. The median follow-up period was 34 mo. RESULTS: LAR was observed in 15 cases (7%) and no chronic rejection was observed. The incidence of hyperlipidemia, chronic renal failure, new-onset post-transplantation diabetes, and deep fungal infection were 13%, 2%, 24%, and 17%, respectively. Conversion from tacrolimus to cyclosporine was required in 38 patients (19%). Multivariate analysis revealed that a cyclosporine-based regimen was significantly associated with LAR. CONCLUSION: Both LAR and drug-induced adverse events happen at a low incidence, supporting the safety and efficacy of the present immunosuppression regimen for living donor liver transplantation.
AIM: To investigate the incidence and risk factors of late-onset acute rejection (LAR) and to clarify the effectiveness of our immunosuppressive regime consisting of life-long administration of tacrolimus and steroids. METHODS: Adult living donor liver transplantation recipients (n=204) who survived more than 6 mo after living donor liver transplantation were enrolled. Immunosuppression was achieved using tacrolimus and methylprednisolone. When adverse effects of tacrolimus were detected, the patient was switched to cyclosporine. Six months after transplantation, tacrolimus or cyclosporine was carefully maintained at a therapeutic level. The methylprednisolone dosage was maintained at 0.05 mg/kg per day by oral administration. Acute rejections that occurred more than 6 mo after the operation were defined as late-onset. The median follow-up period was 34 mo. RESULTS: LAR was observed in 15 cases (7%) and no chronic rejection was observed. The incidence of hyperlipidemia, chronic renal failure, new-onset post-transplantation diabetes, and deep fungal infection were 13%, 2%, 24%, and 17%, respectively. Conversion from tacrolimus to cyclosporine was required in 38 patients (19%). Multivariate analysis revealed that a cyclosporine-based regimen was significantly associated with LAR. CONCLUSION: Both LAR and drug-induced adverse events happen at a low incidence, supporting the safety and efficacy of the present immunosuppression regimen for living donor liver transplantation.
Authors: Paul Greig; Leslie Lilly; Charles Scudamore; Siegfried Erb; Eric Yoshida; Norman Kneteman; Vince Bain; Cameron Ghent; Paul Marotta; David Grant; William Wall; Jean Tchervenkov; Jeffrey Barkun; Andre Roy; Denis Marleau; Vivian McAlister; Kevork Peltekian Journal: Liver Transpl Date: 2003-06 Impact factor: 5.799
Authors: Jacques Pirenne; Raymond Aerts; Takaaki Koshiba; Frank Van Gelder; Tania Roskams; Marie Schetz; Marleen Verhaegen; Peter Lauwers; Johan Fevery; Frederik Nevens Journal: Clin Transplant Date: 2003-06 Impact factor: 2.863
Authors: Robert A Fisher; James J Stone; Luke G Wolfe; Cheryl M Rodgers; Melodie L Anderson; Richard K Sterling; Mitchell L Shiffman; Velimer A Luketic; Melissa J Contos; A Scott Mills; Andrea Ferreira-Gonzalez; Marc P Posner Journal: Clin Transplant Date: 2004-08 Impact factor: 2.863
Authors: Alnoor Ramji; Eric M Yoshida; Vincent G Bain; Norman M Kneteman; Charles H Scudamore; Mang M Ma; Urs P Steinbrecher; Klaus S Gutfreund; Siegfried R Erb; Nilufar Partovi; Stephen W Chung; James Shapiro; Winnie W S Wong Journal: Liver Transpl Date: 2002-10 Impact factor: 5.799
Authors: K Urata; S Kawasaki; H Matsunami; Y Hashikura; T Ikegami; S Ishizone; Y Momose; A Komiyama; M Makuuchi Journal: Hepatology Date: 1995-05 Impact factor: 17.425
Authors: Maja Segedi; Andrzej K Buczkowski; Charles H Scudamore; Eric M Yoshida; Alison C Harris; Kristin DeGirolamo; Stephen W Chung Journal: HPB (Oxford) Date: 2013-02-01 Impact factor: 3.647