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Titolo:
Liver transplantation using sirolimus and minimal corticosteroids (3-day taper)
Autore:
Trotter, JF; Wachs, M; Bak, T; Trouillot, T; Stolpman, N; Everson, GT; Kam, I;
Indirizzi:
Univ Colorado, Hlth Sci Ctr, Div Gastroenterol Hepatol, Denver, CO 80262 USA Univ Colorado Denver CO USA 80262 roenterol Hepatol, Denver, CO 80262 USA Univ Colorado, Hlth Sci Ctr, Div Transplant Surg, Denver, CO 80262 USA Univ Colorado Denver CO USA 80262 v Transplant Surg, Denver, CO 80262 USA
Titolo Testata:
LIVER TRANSPLANTATION
fascicolo: 4, volume: 7, anno: 2001,
pagine: 343 - 351
SICI:
1527-6465(200104)7:4<343:LTUSAM>2.0.ZU;2-2
Fonte:
ISI
Lingua:
ENG
Soggetto:
CYCLOSPORINE; RAPAMYCIN; HYPERCHOLESTEROLEMIA; HYPERTENSION; TACROLIMUS; EFFICACY;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
15
Recensione:
Indirizzi per estratti:
Indirizzo: Trotter, JF Univ Colorado, Hlth Sci Ctr, Div Gastroenterol Hepatol, 4200 E9th Ave,B-154, Denver, CO 80262 USA Univ Colorado 4200 E 9th Ave,B-154 Denver CO USA 80262 262 USA
Citazione:
J.F. Trotter et al., "Liver transplantation using sirolimus and minimal corticosteroids (3-day taper)", LIVER TRANS, 7(4), 2001, pp. 343-351

Abstract

At our center, we have performed liver transplantation since 1995 with a rapid-taper steroid protocol (weaning steroids by day 14 postransplantation). Beginning in 2000, we further reduced the use of corticosteroids to 3 days and added sirolimus to our immunosuppressive regimen. We report our experience with 39 patients who underwent liver transplantation with either tacrolimus or cyclosporin A (Neoral; Novartis Pharmaceuticals Corp., Summit, NJ) and sirolimus, with a 3-day tapered dose of corticosteroids. Thirty-two patients received a cadaveric graft and 7 patients received a right hepatic lobe from a living donor. All patients initially were administered either tacrolimus (0.1 mg/kg/d) or cyclosporin A (10 mg/kg/d) and sirolimus (G mg/dfor 1 day, followed by 2 mg/d), in addition to methylprednisolone on the first 3 days (1, 0.5, and 0.5 g/d) after transplantation. Patients were administered corticosteroids for presumptive or biopsy-proven evidence of acutecellular rejection (methylprednisolone, 1, 0.5, and 0.5 g on 3 successive days). Seventeen patients were administered tacrolimus and 22 patients wereadministered cyclosporin A. Six patients were excluded from analysis because they were administered sirolimus for less than 2 weeks. Mean duration offollow-up was 124 days. Patient survival was 36 of 39 patients (92%), and graft survival was 35 of 39 grafts (89%). Ten of 33 patients (30%) experienced 12 episodes of rejection (7 biopsy proven, 5 presumptive) compared with70% in historical controls (P < .01). OKT3 was required in I of 33 patients (3%) compared with 37% in controls (P < .01). Twenty-six of 33 patients (79%) were not administered prednisone, and 7 of 33 patients (21%) were administered prednisone for reasons other than rejection. Posttransplantation, there was no significant change in values for creatinine, glucose, aspartate aminotransferase, bilirubin, cholesterol, and white blood cell counts. Platelet counts were significantly reduced, and hematocrits were significantly elevated (P < .05). Liver transplantation may be successfully performed with minimal use of corticosteroids by using sirolimus and either tacrolimusor cyclosporin A. Despite the absence of prednisone from our immunosuppressive protocol, the incidence of rejection and OKT3 use was lower than in historical controls. Patient and graft survival rates were identical to thoseof historical controls. The findings in this report will serve as the basis for a formal trial evaluating the efficacy of sirolimus in liver transplantation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/01/20 alle ore 07:01:34