Early Immunosuppressive Exposure of Enteric-Coated-Mycophenolate Sodium Plus Tacrolimus Associated with Acute Rejection in Expanded Criteria Donor Kidney Transplantation

Background： lmmunosuppressive agents are still inefficient in preventing biopsy-proven acute rejection （BPAR） alter expanded criteria donor （ECD） kidney transplantation. The aim of this study was to investigate the relationships between early imrnunosuppressive exposure and the development of BPAR. Methods： We performed a retrospective study of 58 recipients of ECD kidney transplantation treated with enteric-coated-mycophenolate sodium, tacrolirnus （Tac）, and prednisone. The levels of mycophenolic acid-area under the curve （MPA-AUC）0-12h and Tac C0 were measured at the 1st week and the 1st month posttransplant, respectively. The correlation was assessed by multivariate logistic regression. Results： The occurrence rates of BPAR and antibody-mediated rejection were 24.1% and 10.3%, respectively. A low level of MPA-AUC0-12h at the 1st week posttransplant was found in BPAR recipients （38.42 ± 8.37 vs. 50.64 ± 13.22, P 〈 0.01）. In addition, the incidence of BPAR was significantly high （P 〈 0.05） when the MPA-AUC0-12h level was 〈30 mg·h-1·L-1 at the 1st week （ 15.0% vs. 44.4%） or the Tac C0 was 〈4 ng/ml at the 1 st month posttransplant （33.3% vs. 21.6%）. Multivariable logistic regression analysis showed that the MPA-AUC 0-12 h at the 1st week （OR： 0.842, 95% CI： 0.784-0.903） and the Tac C0 at the 1st month （OR： 0.904, 95% C7： 0.822-0.986） had significant inverse correlation with BPA R （ P 〈 0.05 ）. Conclusions： Low-level exposure of MPA and Tac C0 in the early weeks posttransplant reflects an increased acute rejection risk, which suggested that MPA-AUC0-12h 〈30 mg·h-1·L -1 and Tac C0 〈4 ng/ml should be avoided in the first few weeks alter transplantation.

Prognostic factors influencing outcome in adult liver transplantation using hypernatremic organ donation after brain death

Background:Hypernatremic donors was regarded as the expanded criteria donors in liver transplantation.The study was to investigate the effects of donor hypernatremia on the outcomes of liver transplantation and identify the prognostic factors possibly contributing to the poor outcomes.Methods:Donor serum sodium levels before procurement were categorized as normal sodium(<155 mmol/L),moderate high sodium(155–170 mmol/L),and severe high sodium(≥170 mmol/L).Furthermore,we subdivided the 142 hypernatremic donors(≥155 mmol/L)into two subgroups:subgroup A,the exposure time of liver grafts from hypernatremia to reperfusion was<36 h;and subgroup B,the exposure time was≥36 h.The outcomes included initial graft function,survival rates of grafts and recipients,graft loss and early events within the first year following liver transplantation.Results:There were no significant differences in the 1-year survival rates of grafts and recipients,1-year graft loss rates and early events among the normal,moderate high and severe high sodium groups.However,the overall survival rates of grafts and recipients in subgroup A were significantly higher than those in subgroup B.Cox model showed that the exposure time(HR=1.117;95%CI:1.053–1.186;P<0.001),cold ischemia time(HR=1.015;95%CI:1.006–1.024;P=0.001)and MELD(HR=1.061;95%CI:1.003–1.121;P=0.037)were the important prognostic factors contributing to the poor outcomes of recipients with hypernatremic donors.Conclusions:The level of donor sodium immediately before organ procurement does not have negative effects on the early outcomes following adult liver transplantation.For hypernatremia liver donors,minimization of the exposure time from hypernatremia to reperfusion is critical to prevent graft loss.