Perioperative and postoperative use of immunosuppressive agents in liver transplantation

Donor liver steatosis: A risk factor for early new-onset diabetes after liver transplantation

AIMS/INTRODUCTION

To investigate whether donor liver steatosis increases the incidence of new-onset diabetes after transplantation (NODAT) in liver transplant recipients.

MATERIALS AND METHODS

We retrospectively analyzed liver transplant recipients at Zhongshan Hospital, Shanghai, China, from April 2001 to December 2014. The final analysis involved 763 patients. The cumulative incidence of NODAT at 1, 3, 5 and 10 years after liver transplantation was investigated. Furthermore, according to the findings of donor liver biopsy before transplantation, patients were divided into steatotic and non-steatotic donor liver groups, and NODAT incidence was compared between these groups. Multivariate Cox regression was used to explore the risk factors for NODAT in the patients.

RESULTS

Of the 763 donors, 309 (40.5%) had liver steatosis. At the end of follow up, 130 (42.1%) patients in the steatotic donor liver group developed NODAT, an incidence that exceeded that in the non-steatotic donor liver group (P = 0.001). The cumulative incidence of NODAT among all patients at 1, 3, 5, and 10 years after transplantation was 33, 43, 50 and 56%, respectively. The cumulative incidences of NODAT at 1, 3, 5 and 10 years in the steatotic donor liver group were significantly higher than those in the non-steatotic donor liver group (P = 0.003). Multivariate Cox regression analyses showed that donor liver steatosis was an independent risk factor for NODAT among liver transplant recipients, after other potential risk factors were adjusted for (hazard ratio 1.774, 95% confidence interval: 1.025-3.073; P = 0.041).

CONCLUSIONS

Donor liver steatosis increases NODAT incidence among liver transplant recipients.

Following-up of a four-dose daclizumab induction therapy without calcineurin inhibitors in a liver transplantation recipient with severe renal dysfunction: a case report

BACKGROUND

There is debate on the dose schedule and pharmacokinetics of daclizumab in liver transplant recipients.

METHODS

A four-dose course of daclizumab was administered to a patient with severe renal dysfunction. Calcineurin inhibitor therapy initiation was delayed to 86 days posttransplantation.

RESULTS

The patient is well as 480 days after transplantation. No rejection was observed.

CONCLUSIONS

The result suggested the efficacy of our dose schedule, but it will be necessary to confirm it with further pharmacokinetic studies and more cases.

Renal dysfunction in the perioperative liver transplant period

PURPOSE OF REVIEW

Acute kidney failure in the perioperative liver transplant recipients results in an increased hospital length of stay, acute rejection, infection rate and overall mortality. Thus, it is of great importance to be able to recognize, prevent and treat kidney injury.

RECENT FINDINGS

Immediate post liver transplant kidney dysfunction is increased in those with pretransplant kidney failure, hepato-renal syndrome, intraoperative hypotension, intraoperative hypovolemia, aprotinin use and those requiring transfusion of more units of blood products or needing to return to the operating room.

SUMMARY

To date, avoiding risky clinical situations, maintaining homeostasis and a multidisciplinary approach to care have been reasonable approaches to decrease the incidence of postoperative acute kidney injury.