AIM: To describe the long-term outcome of liver transplantation (LT) in patients with pre-transplant renal dysfunction treated with induction therapy and delayed reduced de novo once-daily tacrolimus (T-QD).

PATIENTS AND METHODS: Adult patients with pre-transplant renal dysfunction who received a LT between April 2008 and August 2011 whose initial immunosuppression was based on induction therapy and delayed de novo T-QD comprised the study cohort. Renal function was assessed through the MDRD-4 formula; renal dysfunction was defined as eGFR <60 ml/min. IL-2 receptor antagonists were used for induction therapy and T-QD was started de novo either by oral route or through a naso-gastric tube as soon as the renal function was stabilized. Initial dose of T-QD was 0.1 mg/kg/day or 0.07 mg/kg/day when combined with MMF. Steroids were always used and MMF was indicated according to clinical criteria.

RESULTS: The final sample consisted of 19 patients with a median follow-up of 57.1 months (range 10.3-77.7). Mean pre-transplant eGFR was 45.9± 10.8 ml/min. T-QD was initiated within the first week in 13 patients (68.4%). All patients were on T-QD based therapy by the end of the second week. MMF was initiated in sixteen patients (84.2%) within the first 15 days after transplantation. Evolution of mean Tac trough levels and eGFR at D15, D30, 1 year, 3 years and 5 years were as follows: 5.4 ± 2.2, 4.8 ± 2.1, 5.8 ± 2.5, 3.1 ± 2.0 and 4.2 ± 2.4 ng/mL for the Tac levels and 74.4 ± 25.1, 65.6 ± 23.2, 55.3 ± 11.7, 54.9 ± 11.9 and 55.3 ± 12.7 ml/min for eGFR. T-QD withdrawal occurred in 6 patients (31.6); patients were switched to MMF mono therapy. No patient needed dialysis or kidney transplantation. Biopsy proven acute rejection was observed in 3 patients (15.8%); one of them needed steroid boluses. Five patients (26.3%) developed new onset DM. 1- and 5-year patient survival was 94.7% and 78.9%, respectively.

CONCLUSION: Induction therapy with delayed introduction of de novo once-daily tacrolimus followed by the maintenance of reduced levels of tacrolimus preserves long-term renal function and achieves favorable patient survival in patients with pre-transplant renal dysfunction.

CITATION INFORMATION: Gastaca M., Bustamante J., Ventoso A., Fernandez J., Ruiz P., Testillano M., Prieto M., Salvador P., Palomares I., Senosiain M., Suarez M., Valdivieso A. Long-Term Outcomes of Liver Transplantation in Patients with Pre-Transplant Renal Dysfunction Treated with Induction Therapy and Delayed Reduced De Novo Once-Daily Tacrolimus Am J Transplant. 2017;17 (suppl 3).

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