4 research outputs found
Prognostic model for early acute rejection after liver transplantation
Hepatic graft rejection is a common complication after liver transplantation
(LT), with a maximum incidence within the first weeks. The identification of
high-risk patients for early acute rejection (EAR) might be useful for
clinicians. A series of 133 liver graft recipients treated with calcineurin
inhibitors was retrospectively assessed to identify predisposing factors for EAR
and develop a mathematical model to predict the individual risk of each patient.
The incidence of EAR (< or =45 days after LT) was 35.3%. Multivariate analysis
showed that recipient age, underlying liver disease, and Child's class before LT
were independently associated with the development of EAR. Combining these 3
variables, the following risk score for the development of EAR was obtained: EAR
score [F(x)] = 2.44 + (1.14 x hepatitis C virus cirrhosis) + (2.78 x immunologic
cirrhosis) + (2.51 x metabolic cirrhosis)--(0.08 x recipient age in years) +
(1.65 x Child's class A) [corrected]. Risk for rejection = e(F(x))/1 + e(F(x)).
The combination of age, cause of liver disease, and Child's class may allow us to
predict the risk for EAR
Liver transplantation in cirrhotic patients with diabetes mellitus: Midterm results, survival, and adverse events
Liver cirrhosis is frequently associated with diabetes mellitus (DM), and this
metabolic complication is also frequent after orthotopic liver transplantation
(OLT). The aim of our study is to investigate which factors are associated with
DM before and after OLT and their impact on post-OLT evolution. We evaluated the
prevalence of DM among 115 liver transplant candidates with cirrhosis and
assessed their evolution after OLT (median follow-up, 41 months). Sixteen
candidates had DM requiring pharmacological therapy (group A), 45 candidates had
DM controlled with diet (group B), and 54 candidates did not have DM (group C).
One-year and 3-year actuarial survival rates were 100% and 100% for group A, 91%
and 85% for group B, and 77% and 74% for group C, respectively (P <.03). Post-OLT
DM was more frequent in group A. The incidence of other metabolic complications,
major infections, rejection, and arterial hypertension; the need for
hospitalization; and renal and graft function of patients in groups A, B, and C
were similar. The only risk factor for DM 1 year after OLT on multivariate
analysis was pre-OLT DM requiring pharmacological treatment. The incidence of
complications, need for hospitalization, and renal and graft function 1 year
after OLT for patients with post-OLT DM were similar to those of patients without
post-OLT DM. In conclusion, patients with cirrhosis who have DM have a greater
risk for post-OLT DM, but their midterm survival is not worse than the survival
of those without DM
Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil
The management of liver transplant recipients
with renal function impairment remains controversial
because cyclosporine withdrawal from triple
immunosuppression regimens may be followed
by graft rejection. A nonnephrotoxic and powerful
immunosuppressant such as mycophenolate
mofetil (MMF) could allow a reduction of cyclosporine
dosage or its withdrawal and an improvement
in renal function in these patients. Eleven patients
with serum creatinine levels greater than 1.5
mg/dL, normal graft function, and a rejection-free
period of at least 1 year started MMF at a dose of
2000 mg/d (reduced in case of adverse events)
while cyclosporine dosage was slowly reduced.
At last follow-up (63 6 5 weeks), 7 patients
remained free of cyclosporine (6 of those patients
are also free of steroids), 2 patients reduced their
cyclosporine dose, and 2 patients developed mild
acute rejection that responded to a switch to
tacrolimus therapy. Serum creatinine and urea
levels in the 7 patients free of cyclosporine decreased
from 2.22 6 0.13 to 1.90 6 0.19 mg/dL
(P 5 .05) and 0.95 6 0.10 to 0.60 6 0.10 g/L (P F
.001), respectively. Creatinine clearance increased
from 38.16 6 5.60 to 47.01 6 6.76 mL/min (P 5
.005). Control of arterial hypertension also improved.
Tolerance to MMF was good, but 6 patients
required dose reductions, mainly because
of asymptomatic anemia. In conclusion, in liver
transplant recipients with stable graft function,
MMF may allow cyclosporine dose reduction or
discontinuation, thus improving renal function
and the control of arterial hypertension. This
change of treatment must be carefully monitored
because of the frequent need for MMF dose
reduction and the risk for rejection
Prognostic model for early acute rejection after liver transplantation
Hepatic graft rejection is a common complication after liver transplantation
(LT), with a maximum incidence within the first weeks. The identification of
high-risk patients for early acute rejection (EAR) might be useful for
clinicians. A series of 133 liver graft recipients treated with calcineurin
inhibitors was retrospectively assessed to identify predisposing factors for EAR
and develop a mathematical model to predict the individual risk of each patient.
The incidence of EAR (< or =45 days after LT) was 35.3%. Multivariate analysis
showed that recipient age, underlying liver disease, and Child's class before LT
were independently associated with the development of EAR. Combining these 3
variables, the following risk score for the development of EAR was obtained: EAR
score [F(x)] = 2.44 + (1.14 x hepatitis C virus cirrhosis) + (2.78 x immunologic
cirrhosis) + (2.51 x metabolic cirrhosis)--(0.08 x recipient age in years) +
(1.65 x Child's class A) [corrected]. Risk for rejection = e(F(x))/1 + e(F(x)).
The combination of age, cause of liver disease, and Child's class may allow us to
predict the risk for EAR