Improved Survival in Liver Transplant Patients Receiving Prolonged-release Tacrolimus-based Immunosuppression in the European Liver Transplant Registry (ELTR): An Extension Study

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TitreImproved Survival in Liver Transplant Patients Receiving Prolonged-release Tacrolimus-based Immunosuppression in the European Liver Transplant Registry (ELTR): An Extension Study
Type de publicationJournal Article
Year of Publication2019
AuteursAdam R, Karam V, Cailliez V, Trunecka P, Samuel D, Tisone G, Nemec P, Soubrane O, Schneeberger S, Gridelli B, Bechstein WO, Risaliti A, Line P-D, Vivarelli M, Rossi M, Pirenne J, Klempnauer JL, Rummo A, Di Benedetto F, Zieniewicz K, Troisi R, Paul A, Vali T, Kollmar O, Boudjema K, Hoti E, Colledan M, Pratschke J, Lang H, Popescu I, Ericzon B-G, Strupas K, De Simone P, Kochs E, Heyd B, Gugenheim J, Pinna AD, Bennet W, Kazimi M, Bachellier P, Wigmore SJ, Rasmussen A, Clavien P-A, Hidalgo E, O'Grady JG, Zamboni F, Kilic M, Duvoux C, ELITA
JournalTRANSPLANTATION
Volume103
Pagination1844-1862
Date PublishedSEP
Type of ArticleArticle
ISSN0041-1337
Résumé

Background. We compared, through the European Liver Transplant Registry, long-term liver transplantation outcomes with prolonged-release tacrolimus (PR-T) versus immediate-release tacrolimus (IR-T)-based immunosuppression. This retrospective analysis comprises up to 8-year data collected between 2008 and 2016, in an extension of our previously published study. Methods. Patients with <1 month follow-up were excluded; patients were propensity score matched for baseline characteristics. Efficacy measures included: univariate/multivariate analyses of risk factors influencing graft/patient survival up to 8 years posttransplantation, and graft/patient survival up to 4 years with PR-T versus IR-T. Overall, 13 088 patients were included from 44 European centers; propensity score-matched analyses comprised 3006 patients (PR-T: n = 1002; IR-T: n = 2004). Results. In multivariate analyses, IR-T-based immunosuppression was associated with reduced graft survival (risk ratio, 1.49; P = 0.0038) and patient survival (risk ratio, 1.40; P = 0.0215). There was improvement with PR-T versus IR-T in graft survival (83% versus 77% at 4 y, respectively; P = 0.005) and patient survival (85% versus 80%; P = 0.017). Patients converted from IR-T to PR-T after 1 month had a higher graft survival rate than patients receiving IR-T at last follow-up (P < 0.001), or started and maintained on PR-T (P = 0.019). One graft loss in 4 years was avoided for every 14.3 patients treated with PR-T versus IR-T. Conclusions. PR-T-based immunosuppression might improve long-term outcomes in liver transplant recipients than IR-T-based immunosuppression.

DOI10.1097/TP.0000000000002700