An analysis of tacrolimus-related complications in the first 30 days after liver transplantation

• Main Authors: Lucas Souto Nacif, André Ibrahim David, Rafael Soares Pinheiro, Marcio Augusto Diniz, Wellington Andraus, Ruy Jorge Cruz Junior, Luiz A. Carneiro D′Albuquerque
• Format: Article
• Language: English
• Published: Faculdade de Medicina / USP 2014-11-01
• Series: Clinics
• Subjects: Liver Transplantation; Renal Failure; End-Stage Liver Disease; Tacrolimus; Rejection
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1807-59322014001100745&lng=en&tlng=en

OBJECTIVES: Orthotopic liver transplantation has improved survival in patients with end-stage liver disease; however, therapeutic strategies that achieve ideal immunosuppression and avoid early complications are lacking. To correlate the dose and level of Tacrolimus with early complications, e.g., rejection, infection and renal impairment, after liver transplantation. From November 2011 to May 2013, 44 adult liver transplant recipients were studied in this retrospective comparative study. RESULTS: The most frequent indication for liver transplantation was hepatitis C cirrhosis (47.7%), with a higher prevalence observed in male patients (68.18%). The ages of the subjects ranged from 19-71 and the median age was 55.5 years. The mean length of the hospital stay was 16.1±9.32 days and the mean Model for End-stage Liver Disease score was 26.18±4.28. There were five cases of acute cellular rejection (11.37%) and 16 cases of infection (36.37%). The blood samples that were collected and analyzed over time showed a significant correlation between the Tacrolimus blood level and the deterioration of glomerular filtration rate and serum creatinine (p<0.05). Patients with infections had a higher serum level of Tacrolimus (p = 0.012). The dose and presence of rejection were significantly different (p = 0.048) and the mean glomerular filtration rate was impaired in patients who underwent rejection compared with patients who did not undergo rejection (p = 0.0084). CONCLUSION: Blood Tacrolimus levels greater than 10 ng/ml were correlated with impaired renal function. Doses greater than 0.15 mg/kg/day were associated with the prevention of acute cellular rejection but predisposed patients to infectious disease.