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Comparative long-term evaluation of tacrolimus and cyclosporine in pediatric liver transplantation

Jain, A and Mazariegos, G and Kashyap, R and Green, M and Gronsky, C and Starzl, TE and Fung, J and Reyes, J (2000) Comparative long-term evaluation of tacrolimus and cyclosporine in pediatric liver transplantation. Transplantation, 70 (4). 617 - 625. ISSN 0041-1337

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Abstract

Background. In this report, we compare the long-term outcome of pediatric liver transplantation (LTx) patients maintained with tacrolimus-based and with cyclosporine (CsA)-based immunosuppressive therapy. We examine long-term patient and graft survival, the incidence of rejection, and immunosuppression-related complications. Method. There were 233 consecutive primary LTx in children (ages < 18 years) performed between October 1989 and December 1994 with tacrolimus-based immunosuppressive therapy (Group I). These were compared with 120 consecutive primary LTx performed with CsA-based immunosuppressive therapy between January 1988 and October 1989(Group II). Children in both groups were followed until July 1999. Mean follow-up was 91.41±17.7 months (range 55.6-117.8) for Group I, and 128±6.1 months (range 116.7-138.6) for Group II. Results. At 9 years of follow-up, actuarial patient and graft survival were significantly improved (patient survival 85.4% in Group I vs. 63.8% in Group II, P=0.0001; graft survival Group I 78.9% vs. 60.8% Group II, P=0.0003) and the rate of re -transplantation was significantly lower among patients in Group I (12% in Group I vs. 22.5% in Group II P=0.01). Children in Group I also experienced a significantly reduced incidence of acute rejection (0.97 per patient Group I vs. 1.5 per patient Group II P=0.002) and significantly less steroid resistant acute rejection episodes (3.1% in Group I vs. 8.6% in Group II P=0.0001). The mean steroid dose was significantly lower in Group I compared with Group II at all time points (P=0.0001) after LTx. Freedom from steroid was also significantly higher in Group I compared with Group H at all time points after LTx (ranging from 78% to 84% in Group I and 9% to 32% in Group H during a 1- to 7-year posttransplant period P=0.0001). The rate of hypertension was significantly lower in Group I than Group II (P=0.0001), and the severity of hypertension (need for more than one anti-hypertensive medication) was also significantly lower in Group I than Group II (P=0.0001). Although the rate of posttransplant lymphoproliferative disorder (PTLD) was not significantly different (13.7% Group I vs.8.3% Group II, P=0.13), the survival after PTLD was significantly better for Group I at 81.2% than for Group II at 50% after 5 years (P=0.034). Conclusion. The results suggest that tacrolimus-based therapy provides significant long-term benefit to pediatric LTx patients, evidenced by significantly improved patient and graft survival, reduced rate of rejection, and hypertension with lower steroid doses.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Jain, A
Mazariegos, G
Kashyap, R
Green, M
Gronsky, C
Starzl, TEtes11@pitt.eduTES11
Fung, J
Reyes, J
Centers: Other Centers, Institutes, or Units > Thomas E. Starzl Transplantation Institute
Date: 27 August 2000
Date Type: Publication
Journal or Publication Title: Transplantation
Volume: 70
Number: 4
Page Range: 617 - 625
Institution: University of Pittsburgh
Refereed: Yes
ISSN: 0041-1337
Other ID: uls-drl:31735062120377, Starzl CV No. 2131
Date Deposited: 08 Apr 2010 17:36
Last Modified: 13 Oct 2017 22:55
URI: http://d-scholarship.pitt.edu/id/eprint/5517

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