Publication: Delayed Calcineurin Inhibitor Introduction Without Antibody Induction in Liver Transplantation Is Safe and Helps Preserve Kidney Function
Issued Date
2021-03-01
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ISSN
18732623
00411345
00411345
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2-s2.0-85098630878
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Mahidol University
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SCOPUS
Bibliographic Citation
Transplantation Proceedings. Vol.53, No.2 (2021), 645-648
Suggested Citation
Chutwichai Tovikkai, Somchai Limsrichamrern, Wethit Dumronggittigule, Yongyut Sirivatanauksorn, Prawat Kositamongkol, Prawej Mahawithitwong, Pholasith Sangserestid, Charnwit Assawasirisin Delayed Calcineurin Inhibitor Introduction Without Antibody Induction in Liver Transplantation Is Safe and Helps Preserve Kidney Function. Transplantation Proceedings. Vol.53, No.2 (2021), 645-648. doi:10.1016/j.transproceed.2020.11.005 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78417
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Title
Delayed Calcineurin Inhibitor Introduction Without Antibody Induction in Liver Transplantation Is Safe and Helps Preserve Kidney Function
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Abstract
Introduction: Acute kidney injury (AKI) is common after liver transplantation and affects outcome after liver transplantation. Antibody induction is commonly used to reduce dose and/or to delay introduction of calcineurin inhibitor (CNI) but is very expensive. We propose a modified immunosuppressive protocol that delays administration of CNI for 48 to 72 hours without antibody induction. This study evaluates the results of our new protocol. Material and Methods: A retrospective case-control study was performed. Study patients had induction with steroid and mycophenolate mofetil without antibody induction, and CNI administration was delayed for 48 to 72 hours. Control patients received CNI and steroid induction without antibody induction, and CNI was continued posttransplant. AKI was defined as an increase in serum creatinine level of at least 1.5 times the pretransplant baseline within the first postoperative week. Results: Sixty liver transplant recipients from 2013 to 2015 were included in this study (30 in the delayed CNI group and 30 in the control group). The patient characteristics and intraoperative factors were comparable in both groups. AKI developed in 11 patients in the study group and in 20 patients in the control group (37% vs 66.7%; P = .02). There was no acute rejection observed in the first month in either group. Conclusion: We have demonstrated that delayed CNI introduction without antibody induction is safe and helps preserve kidney function. Antibody induction can be omitted safely in a delayed CNI introduction protocol to reduce the cost of liver transplantation without increasing the risk of acute rejection.