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Korean J Transplant 2021; 35(1): 8-14

Published online March 31, 2021

https://doi.org/10.4285/kjt.20.0043

© The Korean Society for Transplantation

Early use of everolimus improved renal function after adult deceased donor liver transplantation

Seohee Lee , Jong Man Kim , Sangjin Kim , Jinsoo Rhu , Gyu-Seong Choi , Jae-Won Joh

Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Correspondence to: Jong Man Kim
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea
Tel: +82-2-3410-1719
Fax: +82-2-3410-0040
E-mail: yjongman21@gmail.com

Received: September 10, 2020; Revised: October 29, 2020; Accepted: October 29, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Tacrolimus (TAC) is a main therapy for liver transplantation (LT) patients, but it has side effects such as chronic nephrotoxicity that progressively aggravate renal function. The purpose of this study was to retrospectively compare the renal function between a TAC group and a combination of everolimus and reduced TAC (EVR-TAC) group after deceased donor liver transplantation (DDLT).
Methods: The study comprised 131 patients who underwent DDLT between January 2013 and April 2018 at our institution. They received TAC or EVR-TAC after DDLT. Everolimus (EVR) was introduced between 1 and 6 months after DDLT.
Results: Thirty-six of 131 patients (27.5%) received EVR-TAC. The incidence of chronic kidney disease (CKD; estimated glomerular filtration rate, <60 mL/1.73 m2) in the EVRTAC group was higher than in the TAC group (25% vs. 8.4%; P=0.019). Increasing serum creatinine (n=23, 63.9%) was the most common cause for adding EVR to treatment of the posttransplant patients. There were no statistical differences in acute rejection and CKD between the two groups. The TAC trough level was significantly lower in the EVRTAC group than in the TAC group, and the renal function of the EVR-TAC group was worse than that of the TAC group until 1 year after DDLT. However, the renal function of the EVRTAC group improved and became similar to that of TAC group at 3 years posttransplant.
Conclusions: The present study suggests that EVR should be introduced as soon as possible after DDLT to reduce exposure to high doses of TAC to improve the renal function.

Keywords: Renal insufficiency, Immunosuppression, Calcineurin inhibitors

HIGHLIGHTS
  • Early use of everolimus (EVR) in patients with deteriorated renal function after deceased donor liver transplantation (DDLT) shows that renal function improves 2 or 3 years after DDLT.

  • Present study suggests that EVR should be introduced as soon as possible after DDLT to reduce exposure to high doses of tacrolimus to improve the renal function.