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Abstract Details
Evaluation of Longitudinal Exposure to Tacrolimus as a Risk Factor of Chronic Kidney Disease Occurrence Within the First Year Post-Liver Transplantation
Transplantation. 2020 Jun 29.doi: 10.1097/TP.0000000000003384. Online ahead of print.
Pauline Maurel1, Aurélie Prémaud23, Paul Carrier123, Marie Essig23, Louise Barbier34, Annick Rousseau23, Christine Silvain35, Xavier Causse36, Marilyne Debette-Gratien123, Jérémie Jacques1, Pierre Marquet23, Ephrem Salamé34, Véronique Loustaud-Ratti123
Author information
1Hepatology and Gastroenterology Unit, University Hospital of Limoges, 2 avenue Martin Luther King, 87042 Limoges, France.
2INSERM UMR850, Pharmacology and Transplantation, Rue du Pr. Bernard Descottes, 87025 LIMOGES, France.
3FHU SUPORT: University Hospital Federation SUrvival oPtimization in ORgan Transplantation, Limoges, 87000, Tours, 30000, Poitiers 86000, France.
4Department of Digestive Surgery and Liver Transplantation, Trousseau University Hospital, Avenue de la République, 37170 Chambray-lès-Tours, France.
5Hepatology and Gastroenterology Unit, University Hospital of Poitiers, 2 rue de la Milétrie, 86000 Poitiers, France.
6Hepatology and Gastroenterology Unit, Regional Hospital Center of Orléans, 14 avenue de l'hôpital, 45100 Orléans La Source, France.
Abstract
Background: Renal failure is predictive of mortality in the early post liver-transplantation period and calcineurin inhibitors toxicity is a main challenge. Our aim was to assess the impact of longitudinal tacrolimus exposure (TLE) and other variables on CKD-free 1-year-survival.
Methods: Retrospective data of consecutive patients transplanted between 2011 and 2016, and treated with tacrolimus were collected. TLE and all relevant pre- and post-LT predictive factors of CKD were tested and included in a time-to-event model. CKD was defined by repeated estimated GFR (eGFR) values below 60ml/min/1.73m² at least for the last three months before M12 post-LT.
Results: Data from 180 patients were analyzed. CKD-free survival was 74.5% and was not associated with TLE. Pre-LT acute kidney injury (AKI) and eGFR at one-month post-LT (eGFRM1) <60 ml/min/1.73m² were significant predictors of CKD. By distinguishing two situations within AKI (i.e. with or without hepatorenal syndrome (HRS)), only HRS-AKI remained associated to CKD. HRS-AKI and eGFRM1 <60 ml/min/1.73m² increased the risk of CKD (HR= 2.5; 95% CI: 1.2-4.9 and HR=4.8; 95% CI: 2.6-8.8, respectively).
Conclusions: In our study, TLE, unlike HRS AKI and eGFRM1, was not predictive of CKD-free survival at one year post-LT. Our results once again question the reversibility of HRS-AKI.
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