Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients
Impaired kidney function is associated with increased morbidity and mortality in patients undergoing liver transplantation. Although immunosuppressants are essential in these patients, they impair kidney function. This study aimed to compare adverse kidney outcomes between patients treated with a re...
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MDPI AG
2023-07-01
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| Series: | Pharmaceuticals |
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| Online Access: | https://www.mdpi.com/1424-8247/16/8/1087 |
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| author | Heng-Yi Chiang Lung-Chih Li Chien-Ning Hsu Chih-Che Lin Yi-Chia Chan Chih-Chi Wang Chao-Long Chen |
| author_facet | Heng-Yi Chiang Lung-Chih Li Chien-Ning Hsu Chih-Che Lin Yi-Chia Chan Chih-Chi Wang Chao-Long Chen |
| author_sort | Heng-Yi Chiang |
| collection | DOAJ |
| description | Impaired kidney function is associated with increased morbidity and mortality in patients undergoing liver transplantation. Although immunosuppressants are essential in these patients, they impair kidney function. This study aimed to compare adverse kidney outcomes between patients treated with a reduced dose of tacrolimus (calcineurin inhibitor) plus sirolimus or mycophenolate mofetil (MMF) in the liver transplant center at Kaohsiung Chang Gung Memorial Hospital between April 2011 and December 2017. Propensity score matching was used to identify 232 patients. The risk of adverse kidney outcomes was estimated using Cox proportional hazards regression, and changes in kidney function over time were analyzed using linear mixed modeling. Acute kidney disease risks in this study cohort were not significantly different for the two immunosuppressants (aHR 1.04; 95% CI: 0.70–1.55, <i>p</i> = 0.8328). However, sirolimus use was significantly associated with a higher risk of estimated glomerular filtration rate decline > 30% than MMF (aHR, 2.09; 95% CI: 1.33–3.28; <i>p</i> = 0.0014). Our results demonstrate that sirolimus use may have worsened long-term kidney outcomes compared to MMF. Close monitoring of kidney function, dose adjustment, and timely transition to MMF is necessary for LT patients receiving sirolimus. |
| first_indexed | 2024-03-10T23:40:04Z |
| format | Article |
| id | doaj.art-ef2131b519dd4b01a6781710d527e006 |
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| issn | 1424-8247 |
| language | English |
| last_indexed | 2024-03-10T23:40:04Z |
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| series | Pharmaceuticals |
| spelling | doaj.art-ef2131b519dd4b01a6781710d527e0062023-11-19T02:33:42ZengMDPI AGPharmaceuticals1424-82472023-07-01168108710.3390/ph16081087Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant RecipientsHeng-Yi Chiang0Lung-Chih Li1Chien-Ning Hsu2Chih-Che Lin3Yi-Chia Chan4Chih-Chi Wang5Chao-Long Chen6Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDivision of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanDepartment of Pharmacy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanLiver Transplant Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanLiver Transplant Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanLiver Transplant Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanLiver Transplant Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, TaiwanImpaired kidney function is associated with increased morbidity and mortality in patients undergoing liver transplantation. Although immunosuppressants are essential in these patients, they impair kidney function. This study aimed to compare adverse kidney outcomes between patients treated with a reduced dose of tacrolimus (calcineurin inhibitor) plus sirolimus or mycophenolate mofetil (MMF) in the liver transplant center at Kaohsiung Chang Gung Memorial Hospital between April 2011 and December 2017. Propensity score matching was used to identify 232 patients. The risk of adverse kidney outcomes was estimated using Cox proportional hazards regression, and changes in kidney function over time were analyzed using linear mixed modeling. Acute kidney disease risks in this study cohort were not significantly different for the two immunosuppressants (aHR 1.04; 95% CI: 0.70–1.55, <i>p</i> = 0.8328). However, sirolimus use was significantly associated with a higher risk of estimated glomerular filtration rate decline > 30% than MMF (aHR, 2.09; 95% CI: 1.33–3.28; <i>p</i> = 0.0014). Our results demonstrate that sirolimus use may have worsened long-term kidney outcomes compared to MMF. Close monitoring of kidney function, dose adjustment, and timely transition to MMF is necessary for LT patients receiving sirolimus.https://www.mdpi.com/1424-8247/16/8/1087sirolimusmycophenolate mofetilliver transplantationacute kidney diseasechronic kidney disease |
| spellingShingle | Heng-Yi Chiang Lung-Chih Li Chien-Ning Hsu Chih-Che Lin Yi-Chia Chan Chih-Chi Wang Chao-Long Chen Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients Pharmaceuticals sirolimus mycophenolate mofetil liver transplantation acute kidney disease chronic kidney disease |
| title | Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients |
| title_full | Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients |
| title_fullStr | Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients |
| title_full_unstemmed | Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients |
| title_short | Impact of Sirolimus versus Mycophenolate Mofetil on Kidney Function after Calcineurin Inhibitor Dose Reduction in Liver Transplant Recipients |
| title_sort | impact of sirolimus versus mycophenolate mofetil on kidney function after calcineurin inhibitor dose reduction in liver transplant recipients |
| topic | sirolimus mycophenolate mofetil liver transplantation acute kidney disease chronic kidney disease |
| url | https://www.mdpi.com/1424-8247/16/8/1087 |
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