One Thousand Consecutive Primary Liver Transplants Under Tacrolimus Immunosuppression: A 17- to 20-Year Longitudinal Follow-Up

作者：Ashokkumar B. Jain, Ashish Singhal, Paulo Fontes, George Vincent Mazariegos, Michael DeVera, Thomas V. Cacciarelli, Roberto López, Rakesh K. Sindhi, Abhi Humar, James Wallis Marsh · 发表于：Transplantation · 年份：2011 · DOI：10.1097/tp.0b013e3182129215 · 被引用次数：41 · 研究领域：Organ Transplantation Techniques and Outcomes、Renal Transplantation Outcomes and Treatments、Liver Disease and Transplantation

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, wit...