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Tacrolimus therapy after LT reduced incidence of chronic kidney disease

Liver transplant recipients in China who underwent immunosuppression therapy with tacrolimus after transplantation had a reduced risk for chronic kidney disease and higher overall survival rate, according to new data.

Medical records of 689 liver transplant recipients from a single Chinese center between March 1999 and December 2012 were analyzed. All patients underwent immunosuppression therapy after liver transplantation (LT) with either a low-dose of tacrolimus (TAC; 0.05-0.1 mg/kg daily to start) or cyclosporine A (CSA; 5-10 mg/kg daily to start) and prednisone with or without mycophenolate mofetil (MMF; 1-1.5 g daily). Renal dysfunction and chronic kidney disease (CKD) incidence — defined by a glomerular filtration rate (GFR) of less than 60 mL/minute per 1.73 m² for 3 months post-LT — were measured. Median follow-up was 24 months.

The incidence rate of CKD among patients who received low-dose TAC plus MMF (7.7%) was lower compared with the low-dose TAC group (15.9%), high-dose TAC group (24.6%) and high-dose TAC/MMF group (18.5%).

The cumulative incidence of CKD at 12, 36 and 60 months was higher among patients who received CSA therapy (20%, 23.1% and 26.3%) compared with those who received TAC therapy (10.2%, 11.9% and 13.8%) (P<.05), respectively. Among all patients, 16.7% developed CKD during follow-up.

The cumulative survival rate 5 years post-transplant was higher among patients without CKD compared with patients with CKD (82.2% vs. 61.7%; P<.05). No differences were observed between pre-LT renal dysfunction and any post-LT rejection for the TAC, CSA and all subgroups of patients.

“We showed that in LT patients, the optimal calcineurin inhibitor is low-dose TAC combined with MMF,” the researchers concluded. “This treatment was associated with a better long-term GFR (10 mL/minute per 1.73 m²), thereby decreasing renal toxicity, and a higher patient survival rate.”

Disclosure: Relevant financial disclosures were not provided by researchers.