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

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.

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Corrigendum to “Risk factors and associated outcomes of early acute kidney injury in pediatric liver transplant recipients: A retrospective study” [J Pediatr Surg 55 (2020) 446–450]

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2020.02.023 ◽

2020 ◽

Vol 55 (4) ◽

pp. 781 ◽

Cited By ~ 1

Author(s):

Yimao Zhang ◽

Bo Xiang ◽

Yang Wu ◽

Xiaolong Xie ◽

Junxiang Wang ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Retrospective Study ◽

Liver Transplant ◽

Kidney Injury ◽

Transplant Recipients ◽

Pediatric Liver ◽

Liver Transplant Recipients ◽

Pediatric Liver Transplant

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Sa1580 PERI-OPERATIVE PREDICTORS OF ACUTE KIDNEY INJURY AMONG LIVER TRANSPLANT RECIPIENTS

Gastroenterology ◽

10.1016/s0016-5085(20)34005-1 ◽

2020 ◽

Vol 158 (6) ◽

pp. S-1334

Author(s):

Rachel Berkowitz ◽

Nicholas Douville ◽

Graciela Mentz ◽

Pratima Sharma ◽

Christopher Sonnenday

Keyword(s):

Acute Kidney Injury ◽

Liver Transplant ◽

Kidney Injury ◽

Transplant Recipients ◽

Liver Transplant Recipients

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Neutrophil Gelatinase-Associated Lipocalin Is Not Associated with Tacrolimus-Induced Acute Kidney Injury in Liver Transplant Patients Who Received Mycophenolate Mofetil with Delayed Introduction of Tacrolimus

International Journal of Molecular Sciences ◽

10.3390/ijms20123103 ◽

2019 ◽

Vol 20 (12) ◽

pp. 3103 ◽

Cited By ~ 1

Author(s):

Mio Fukuda ◽

Kimitaka Suetsugu ◽

Soichiro Tajima ◽

Yurie Katsube ◽

Hiroyuki Watanabe ◽

...

Keyword(s):

Liver Transplantation ◽

Acute Kidney Injury ◽

Mycophenolate Mofetil ◽

Liver Transplant ◽

Kidney Injury ◽

Transplant Recipients ◽

Fatty Acid Binding ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase ◽

Liver Transplant Recipients

Tacrolimus is widely used as an immunosuppressant in liver transplantation, and tacrolimus-induced acute kidney injury (AKI) is a serious complication. The urinary neutrophil gelatinase-associated lipocalin (NGAL) level has been linked to tacrolimus-induced AKI in patients starting tacrolimus treatment the morning after liver transplantation. Here we tested this association using a different immunosuppression protocol: Mycophenolate mofetil administration beginning on Postoperative Day 1 and tacrolimus administration beginning on Postoperative Day 2 or 3. Urine samples were collected from 26 living donor liver transplant recipients before (Postoperative Day 1) and after (Postoperative Day 7 or 14) tacrolimus administration. NGAL levels were measured via enzyme-linked immunosorbent assays, as were those of three additional urinary biomarkers for kidney diseases: Monocyte chemotactic protein-1 (MCP-1), liver-type fatty acid-binding protein (L-FABP), and human epididymis secretory protein 4 (HE4). HE4 levels after tacrolimus administration were significantly higher in patients who developed AKI (n = 6) than in those who did not (n = 20), whereas NGAL, MCP-1, and L-FABP levels did not differ significantly before or after tacrolimus administration. These findings indicate that NGAL may not be a universal biomarker of AKI in tacrolimus-treated liver transplant recipients. To reduce the likelihood of tacrolimus-induced AKI, our immunosuppression protocol is recommended.

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