Abstract

Background: Nephrotoxicity of calcineurine inhibitors (CI) may exert a detrimental effect, particularly in liver transplant (OLTx) recipients with an already impaired kidney function. Immunosuppression with daclizumab permits delayed introduction of CI, and may be preferred in patients with kidney dysfunction. Aim: Retrospective analysis of our experience in immunosuppression with daclizumab in patients with impaired kidney function transplanted in our centre.
Material/Methods: One hundred and sixty eight patients were analyzed. Subjects who died within 10 days after OLTx due to surgical complications were excluded. Serum creatinine (Cr) >1.5 mg/dl was an indication for a protocol with daclizumab (50 mg i.v., day 0 and day 4), mycophenolate mofetil (MMF) 500 mg twice daily i.v./orally and prednisolone tapering doses from day 0 after OLTx. CI were introduced on day 4-15 after OLTx. Patients with Cr below 1.5mg/dl received immunosuppression with CI+MMF+steroids or CI+steroids. Data are presented as mean ±SD. Statistical analysis was done with Anova and paired t-test. P values <0.05 were considered significant.
Results: Fourteen patients fulfilled criterion for immunosuppression with daclizumab. Their Cr and creatinine clearance (CrCl) at OLTx were 2.85±1.22 mg/dl and 19±11 ml/min respectively. In remaining 154 patients Cr and CrCl were 0.88±0.3mg/dl and 107±82ml/min. respectively. At discharge, in daclizumab group Cr and CrCl were 0.97±0.45 mg/dl and 86±34 ml/min. (p<0.0001 for both, when compared to values at OLTx). Both Cr and CrCl at discharge were not statistically different when compared to Cr and CrCl in patients transplanted with the normal kidney function. The incidence of acute rejection was 14% in daclizumab group and 18% in the others (p=NS). Conclusions: Immunosuppression with daclizumab and delayed introduction of CI is safe and does not increase the risk of acute rejection thus offers an excellent therapeutic option in patients transplanted with impaired kidney function.

Keywords: Liver Transplantation, clinical outcome