One thousand consecutive primary liver transplants under tacrolimus immunosuppression: A 17- to 20-year longitudinal follow-up

Ashokkumar Jain, Ashish Singhal, Paulo Fontes, George Mazariegos, Michael E. Devera, Thomas Cacciarelli, Roberto C. Lopez, Rakesh Sindhi, Abhi Humar, J. Wallis Marsh

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Background: Tacrolimus has proven to be a potent immunosuppressive agent in orthotopic liver transplantation (OLT). The aim of this study is to examine its long-term efficacy and safety. METHODS AND RESULTS.: One thousand consecutive primary OLTs performed between August 1989 and December 1992 and maintained under tacrolimus-based immunosuppression were followed up until January 2009. Patient and graft survivals with corresponding causes of death and retransplantation, maintenance immunosuppression, and adverse effects were examined. The study population includes 600 males and 400 females comprising 166 children, 630 adults, and 204 seniors. The mean follow-up was 17.83 (range, 16.1-19.50) years. The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively. At the last follow-up, 442 patients were alive; 133 (77.1%) children, 265 (34.5%) adults, and 44 (16.1%) seniors (P=0.0001). After the first post-OLT year, cardiopulmonary events, recurrence of primary disease, and malignancy were the main causes of death. Overall, 183 recipients underwent retransplants; mainly for primary nonfunction, hepatic artery thrombosis, and recurrent primary disease, 180 required dialysis, and 45 underwent kidney transplant. A total of 97.7% of the survivors were on tacrolimus and 26.2% were also receiving adjunctive immunosuppressants at the last follow-up. CONCLUSIONS.: The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively, with significantly better survival among children. Age-related complications, recurrence of primary disease, and malignancy were the major causes of late graft loss. Graft loss related to immunologic reasons was rare. The prevention of recurrent disease and newer immunosuppressive regimen will further improve these results.

Original languageEnglish (US)
Pages (from-to)1025-1030
Number of pages6
JournalTransplantation
Volume91
Issue number9
DOIs
StatePublished - May 15 2011

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A 17
Tacrolimus
Immunosuppression
Graft Survival
Immunosuppressive Agents
Transplants
Liver
Liver Transplantation
Cause of Death
Recurrence
Hepatic Artery
Survivors
Dialysis
Neoplasms
Thrombosis
Maintenance
Kidney
Safety
Survival
Population

All Science Journal Classification (ASJC) codes

  • Transplantation

Cite this

Jain, Ashokkumar ; Singhal, Ashish ; Fontes, Paulo ; Mazariegos, George ; Devera, Michael E. ; Cacciarelli, Thomas ; Lopez, Roberto C. ; Sindhi, Rakesh ; Humar, Abhi ; Marsh, J. Wallis. / One thousand consecutive primary liver transplants under tacrolimus immunosuppression : A 17- to 20-year longitudinal follow-up. In: Transplantation. 2011 ; Vol. 91, No. 9. pp. 1025-1030.
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title = "One thousand consecutive primary liver transplants under tacrolimus immunosuppression: A 17- to 20-year longitudinal follow-up",
abstract = "Background: Tacrolimus has proven to be a potent immunosuppressive agent in orthotopic liver transplantation (OLT). The aim of this study is to examine its long-term efficacy and safety. METHODS AND RESULTS.: One thousand consecutive primary OLTs performed between August 1989 and December 1992 and maintained under tacrolimus-based immunosuppression were followed up until January 2009. Patient and graft survivals with corresponding causes of death and retransplantation, maintenance immunosuppression, and adverse effects were examined. The study population includes 600 males and 400 females comprising 166 children, 630 adults, and 204 seniors. The mean follow-up was 17.83 (range, 16.1-19.50) years. The overall 20-year actuarial patient and graft survivals were 35.8{\%} and 32.6{\%}, respectively. At the last follow-up, 442 patients were alive; 133 (77.1{\%}) children, 265 (34.5{\%}) adults, and 44 (16.1{\%}) seniors (P=0.0001). After the first post-OLT year, cardiopulmonary events, recurrence of primary disease, and malignancy were the main causes of death. Overall, 183 recipients underwent retransplants; mainly for primary nonfunction, hepatic artery thrombosis, and recurrent primary disease, 180 required dialysis, and 45 underwent kidney transplant. A total of 97.7{\%} of the survivors were on tacrolimus and 26.2{\%} were also receiving adjunctive immunosuppressants at the last follow-up. CONCLUSIONS.: The overall 20-year actuarial patient and graft survivals were 35.8{\%} and 32.6{\%}, respectively, with significantly better survival among children. Age-related complications, recurrence of primary disease, and malignancy were the major causes of late graft loss. Graft loss related to immunologic reasons was rare. The prevention of recurrent disease and newer immunosuppressive regimen will further improve these results.",
author = "Ashokkumar Jain and Ashish Singhal and Paulo Fontes and George Mazariegos and Devera, {Michael E.} and Thomas Cacciarelli and Lopez, {Roberto C.} and Rakesh Sindhi and Abhi Humar and Marsh, {J. Wallis}",
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Jain, A, Singhal, A, Fontes, P, Mazariegos, G, Devera, ME, Cacciarelli, T, Lopez, RC, Sindhi, R, Humar, A & Marsh, JW 2011, 'One thousand consecutive primary liver transplants under tacrolimus immunosuppression: A 17- to 20-year longitudinal follow-up', Transplantation, vol. 91, no. 9, pp. 1025-1030. https://doi.org/10.1097/TP.0b013e3182129215

One thousand consecutive primary liver transplants under tacrolimus immunosuppression : A 17- to 20-year longitudinal follow-up. / Jain, Ashokkumar; Singhal, Ashish; Fontes, Paulo; Mazariegos, George; Devera, Michael E.; Cacciarelli, Thomas; Lopez, Roberto C.; Sindhi, Rakesh; Humar, Abhi; Marsh, J. Wallis.

In: Transplantation, Vol. 91, No. 9, 15.05.2011, p. 1025-1030.

Research output: Contribution to journalArticle

TY - JOUR

T1 - One thousand consecutive primary liver transplants under tacrolimus immunosuppression

T2 - A 17- to 20-year longitudinal follow-up

AU - Jain, Ashokkumar

AU - Singhal, Ashish

AU - Fontes, Paulo

AU - Mazariegos, George

AU - Devera, Michael E.

AU - Cacciarelli, Thomas

AU - Lopez, Roberto C.

AU - Sindhi, Rakesh

AU - Humar, Abhi

AU - Marsh, J. Wallis

PY - 2011/5/15

Y1 - 2011/5/15

N2 - Background: Tacrolimus has proven to be a potent immunosuppressive agent in orthotopic liver transplantation (OLT). The aim of this study is to examine its long-term efficacy and safety. METHODS AND RESULTS.: One thousand consecutive primary OLTs performed between August 1989 and December 1992 and maintained under tacrolimus-based immunosuppression were followed up until January 2009. Patient and graft survivals with corresponding causes of death and retransplantation, maintenance immunosuppression, and adverse effects were examined. The study population includes 600 males and 400 females comprising 166 children, 630 adults, and 204 seniors. The mean follow-up was 17.83 (range, 16.1-19.50) years. The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively. At the last follow-up, 442 patients were alive; 133 (77.1%) children, 265 (34.5%) adults, and 44 (16.1%) seniors (P=0.0001). After the first post-OLT year, cardiopulmonary events, recurrence of primary disease, and malignancy were the main causes of death. Overall, 183 recipients underwent retransplants; mainly for primary nonfunction, hepatic artery thrombosis, and recurrent primary disease, 180 required dialysis, and 45 underwent kidney transplant. A total of 97.7% of the survivors were on tacrolimus and 26.2% were also receiving adjunctive immunosuppressants at the last follow-up. CONCLUSIONS.: The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively, with significantly better survival among children. Age-related complications, recurrence of primary disease, and malignancy were the major causes of late graft loss. Graft loss related to immunologic reasons was rare. The prevention of recurrent disease and newer immunosuppressive regimen will further improve these results.

AB - Background: Tacrolimus has proven to be a potent immunosuppressive agent in orthotopic liver transplantation (OLT). The aim of this study is to examine its long-term efficacy and safety. METHODS AND RESULTS.: One thousand consecutive primary OLTs performed between August 1989 and December 1992 and maintained under tacrolimus-based immunosuppression were followed up until January 2009. Patient and graft survivals with corresponding causes of death and retransplantation, maintenance immunosuppression, and adverse effects were examined. The study population includes 600 males and 400 females comprising 166 children, 630 adults, and 204 seniors. The mean follow-up was 17.83 (range, 16.1-19.50) years. The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively. At the last follow-up, 442 patients were alive; 133 (77.1%) children, 265 (34.5%) adults, and 44 (16.1%) seniors (P=0.0001). After the first post-OLT year, cardiopulmonary events, recurrence of primary disease, and malignancy were the main causes of death. Overall, 183 recipients underwent retransplants; mainly for primary nonfunction, hepatic artery thrombosis, and recurrent primary disease, 180 required dialysis, and 45 underwent kidney transplant. A total of 97.7% of the survivors were on tacrolimus and 26.2% were also receiving adjunctive immunosuppressants at the last follow-up. CONCLUSIONS.: The overall 20-year actuarial patient and graft survivals were 35.8% and 32.6%, respectively, with significantly better survival among children. Age-related complications, recurrence of primary disease, and malignancy were the major causes of late graft loss. Graft loss related to immunologic reasons was rare. The prevention of recurrent disease and newer immunosuppressive regimen will further improve these results.

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