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Gewählte Publikation:

SHR Neuro Krebs Kardio Lipid

Leiskau, C; Rajanayagam, J; Pfister, ED; Goldschmidt, I; Junge, N; Karch, A; Lerch, C; Richter, N; Lehner, F; Schrem, H; Baumann, U.
Side effects and efficacy of renal sparing immunosuppression in pediatric liver transplantation-A single center matched cohort study.
Pediatr Transplant. 2018; 22(5): e13207-e13207.
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Autor/innen der Med Uni Graz:
Schrem Harald Heinrich
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Abstract:
Immunosuppressive combination therapy with MMF can reduce CNI associated nephrotoxicity. We investigated effectiveness and safety of de novo MMF-tacrolimus based immunosuppression after pLTx. Patients after pLTx receiving immunosuppression with MMF/tacrolimus (MMF/TAC) were compared to retrospectively selected age- and diagnosis-matched patients with tacrolimus monotherapy (TAC) and cyclosporine/prednisolone therapy (CSA) (19 patients each, n = 57). Effectiveness, renal function and side effects were analyzed for 1 year after pLTx. Tacrolimus reduction in combination therapy (0.7 μg/L over the year) was lower than aspired (2 μg/L). Acute BPAR occurred equally in MMF/TAC and TAC groups (31.6% each), being slightly higher in CSA group (42.1%; OR = 1.5; 95% CI = 0.42-5.44; P = .5). GFR deteriorated comparably in all 3 groups (P < .01 each) without significant differences between the groups. Septicemia was detected significantly more often in MMF/TAC (73.6%) than in TAC (31.6%) (OR 4.17; 1.07-16.27; P = .04). EBV reactivation occurred more often in CSA patients (84.2%) than in MMF/TAC (47.4%; OR 5.16; 0.98-27.19; P = .05) and TAC patients (52.6%; OR 8.16; 1.48-44.89; P = .02) the same was true for other viral infections (47.4% (CSA) vs 15.8% (TAC); OR 4.21; 0.95-18.55; P = .05). Our study does not provide additional evidence for a benefit of initial use of MMF/TAC over TAC regarding renal function, but raises concerns regarding a potentially increased risk of serious infections under MMF/TAC compared to TAC monotherapy at equivalent renal outcome; our study is, however, limited by the minor CNI reduction in combination therapy. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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Child, Preschool -
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Female -
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Logistic Models -
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calcineurin inhibitor
infections
mycophenolate mofetil
nephrotoxicity
tacrolimus
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