The benefit of sirolimus maintenance immunosuppression and rabbit antithymocyte globulin induction in liver transplant recipients that develop acute kidney injury in the early postoperative period.

Benjamin T Duhart,James D Eason,Amy G Krauss,Winston A Ally,Vinaya Rao,Jason M Vanatta,Joanna Q Hudson

doi:10.1155/2015/926168

Abstract

Published data are limited describing renal outcomes in orthotopic liver transplant (OLT) recipients prescribed sirolimus (SRL) maintenance immunosuppression (MIS) and rabbit antithymocyte globulin (rATG) induction. We investigated whether SRL MIS and rATG induction facilitated recovery of acute kidney injury in the early postoperative period. This retrospective descriptive study screened 308 consecutive OLTs performed between 2006 and 2009. All patients received rATG induction with steroid avoidance. MIS consisted of SRL or TAC with mycophenolate mofetil. A total of 197 patients were included: 168 (85%) received TAC and 29 (15%) received SRL for a median of 365 days. Demographics were similar between groups except for a higher incidence of pretransplant renal dysfunction in the SRL recipients (SRL 59% versus TAC 21%; P < 0.05). The eGFR was significantly (P < 0.05) higher for all time points in the TAC group with the exception of month 2. However, improvement in eGFR was significantly (P < 0.05) greater in the SRL group postoperatively. Our study suggests that rATG induction and SRL maintenance immunosuppression facilitate renal recovery for liver transplant recipients that develop acute kidney injury in the early postoperative period.

Highlights

Renal dysfunction following orthotopic liver transplant (OLT) is a common, posttransplant complication with a 5year cumulative incidence of 18.1% and is associated with significant morbidity and mortality [1,2,3]
Our study suggests that rabbit antithymocyte globulin (rATG) induction and SRL maintenance immunosuppression facilitate renal recovery for liver transplant recipients that develop acute kidney injury in the early postoperative period
Serum creatinine was significantly elevated, and eGFR significantly decreased in patients receiving SRL on the day of maintenance immunosuppression (MIS) initiation

Summary

Introduction

Renal dysfunction following orthotopic liver transplant (OLT) is a common, posttransplant complication with a 5year cumulative incidence of 18.1% and is associated with significant morbidity and mortality [1,2,3] Calcineurin inhibitors such as tacrolimus (TAC) and cyclosporine have improved patient and graft survival over the past decade, their use can be associated with significant acute reversible and chronic irreversible nephrotoxicity [4]. The conversion studies describing SRL therapy without concomitant calcineurin inhibitors often delayed initiation of SRL until after the early postoperative period due Journal of Transplantation to concerns of hepatic artery thrombosis [14,15,16]. These patients were essentially converted from calcineurin inhibitors to SRL after postoperative day 30 and did not receive rATG induction

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