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Improved Survival in Liver Transplant Patients Receiving Prolonged-release Tacrolimus-based Immunosuppression in the European Liver Transplant Registry (ELTR): An Extension Study

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  • René Adam
  • Vincent Karam
  • Valérie Cailliez
  • Pavel Trunečka
  • Didier Samuel
  • Giuseppe Tisone
  • Petr Němec
  • Olivier Soubrane
  • Stefan Schneeberger
  • Bruno Gridelli
  • Wolf O Bechstein
  • Andrea Risaliti
  • Pal-Dag Line
  • Marco Vivarelli
  • Massimo Rossi
  • Jacques Pirenne
  • Jurgen L Klempnauer
  • Aleh Rummo
  • Fabrizio Di Benedetto
  • Krzysztof Zieniewicz
  • Roberto Troisi
  • Andreas Paul
  • Toomas Vali
  • Otto Kollmar
  • Karim Boudjema
  • Emir Hoti
  • Michele Colledan
  • Johan Pratschke
  • Hauke Lang
  • Irinel Popescu
  • Bo-Goran Ericzon
  • Kestutis Strupas
  • Paolo De Simone
  • Eberhard Kochs
  • Bruno Heyd
  • Jean Gugenheim
  • Antonio D Pinna
  • William Bennet
  • Mirjalal Kazimi
  • Philippe Bachellier
  • Stephen J Wigmore
  • Allan Rasmussen
  • Pierre-Alain Clavien
  • Ernest Hidalgo
  • John G O'Grady
  • Frausto Zamboni
  • Murat Kilic
  • Christophe Duvoux
  • all contributing centers (www.eltr.org) and the European Liver and Intestine Transplant Association (ELITA)
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BACKGROUND: We compared, through the European Liver Transplant Registry, long-term liver transplantation outcomes with prolonged-release tacrolimus (PR-T) versus immediate-release tacrolimus (IR-T)-based immunosuppression. This retrospective analysis comprises up to 8-year data collected between 2008 and 2016, in an extension of our previously published study.

METHODS: Patients with <1 month follow-up were excluded; patients were propensity score matched for baseline characteristics. Efficacy measures included: univariate/multivariate analyses of risk factors influencing graft/patient survival up to 8 years posttransplantation, and graft/patient survival up to 4 years with PR-T versus IR-T. Overall, 13 088 patients were included from 44 European centers; propensity score-matched analyses comprised 3006 patients (PR-T: n = 1002; IR-T: n = 2004).

RESULTS: In multivariate analyses, IR-T-based immunosuppression was associated with reduced graft survival (risk ratio, 1.49; P = 0.0038) and patient survival (risk ratio, 1.40; P = 0.0215). There was improvement with PR-T versus IR-T in graft survival (83% versus 77% at 4 y, respectively; P = 0.005) and patient survival (85% versus 80%; P = 0.017). Patients converted from IR-T to PR-T after 1 month had a higher graft survival rate than patients receiving IR-T at last follow-up (P < 0.001), or started and maintained on PR-T (P = 0.019). One graft loss in 4 years was avoided for every 14.3 patients treated with PR-T versus IR-T.

CONCLUSIONS: PR-T-based immunosuppression might improve long-term outcomes in liver transplant recipients than IR-T-based immunosuppression.

Original languageEnglish
JournalTransplantation
Volume103
Issue number9
Pages (from-to)1844-1862
Number of pages19
ISSN0041-1337
DOIs
Publication statusPublished - Sep 2019

ID: 59210915