Date: Saturday, May 2, 2015
Session Name: Poster Session A: Liver: Immunosuppression and Rejection
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Exhibit Hall E
In our previously published study, we concluded the safety of everolimus (EVR) in early stage after living donor liver transplantation (LDLT). In this large scale study, we intend to analyse long term effects of EVR used along with tacrolimus (TAC) as primary immunosuppression on graft functions, renal functions and hepatocellular carcinoma recurrence (HCC).
Material and Methods:
From January 2012 till October 2014, 215 recipients that underwent LDLT received TAC-EVR based primary immunosuppression within 1st month of transplantation (4th to 20th day after transplant) with minimum 2 months of follow up were included in study cohort. A subgroup HCC patients (n=30) with follow up of 2 years or more was also studied for the recurrence of HCC.
The mean age of cohort (n=173, M:F, 134:39) was 54.01 ± 10.17 (range, 2-73 years). The average EVR dose was 1.09 ± 0.20 mg with a trough level 3.47 ± 1.53 ng/ml (range, 1.5-11.2) at the end of 3 months. None of the patients suffered from hepatic artery thrombosis and/or wound dehiscence. Acute rejection episodes based on laboratory data & clinical suspicion needing steroid administration occurred in 5 recipients. The mean AST, ALT & total Bilirubin levels at latest follow up were 48.62 ± 62.96 IU/ml, 48.23 ± 61.08 IU/ml and 0.75 ± 0.65 mg/dl, respectively. The mean serum creatinine at 1 month, 6 months and 1 year was 1.26 ± 0.81 mg/dl, 1.40 ± 1.08 mg/dl and 1.42 ± 1.01 mg/dl, respectively. Renal dysfunction was present in 35 patients before transplantation. In recipients without end-stage-renal disease (n=8), renal functions improved in 48.18% (n=13) of patients while remained stable in 25.92% of patients (n=7). However, 7 patients showed further deterioration of their renal functions. New onset renal dysfunction occurred in 6.97% (15/215) of the recipients during the follow up. In HCC cohort (n=30), at median 30 months of follow up, HCC recurrence occurred in 30% (n=9). For patients within UCSF criteria, the HCC recurrence was 16.66% (3/18) while patients beyond UCSF, it was found to be 50% (6/12).
Early usage of EVR in LDLT is safe without risk of hepatic arterial thrombosis with stable graft functions and has positive impact on renal function improvement. For the recipients within UCSF criteria, at median follow up of 30 months the recurrence of HCC appeared to be reduced.
To cite this abstract in AMA style:Thorat A, Hsieh Y-W, Yang H-R, Yeh C-C, Chen T-H, Hsu S-C, Jeng L-B. Effects of Early Everolimus Use for Immunosuppression in Living Donor Liver Transplant Recipients- An Analysis of 215 Sequential Patients [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/effects-of-early-everolimus-use-for-immunosuppression-in-living-donor-liver-transplant-recipients-an-analysis-of-215-sequential-patients/. Accessed February 28, 2020.
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