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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Published in:Pharmaceuticals (Basel, Switzerland) Switzerland), 2023-07, Vol.16 (8), p.1087
Main Authors: Chiang, Heng-Yi, Li, Lung-Chih, Hsu, Chien-Ning, Lin, Chih-Che, Chan, Yi-Chia, Wang, Chih-Chi, Chen, Chao-Long
Format: Article
Language:English
Subjects:
acute kidney disease
Analysis
Cholangitis
chronic kidney disease
Comparative analysis
Dosage and administration
FDA approval
Health aspects
Hepatitis
Hospital utilization
Ischemia
Kidney diseases
Kidney function tests
Length of stay
Liver
Liver cancer
Liver diseases
liver transplantation
Liver transplants
Mycophenolate mofetil
Organ transplant recipients
sirolimus
Transplantation
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Summary: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, p = 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; p = 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.
ISSN:1424-8247
1424-8247
DOI:10.3390/ph16081087