Long-term outcome of ketoconazole and tacrolimus coadministration in kidney transplant patients

AIM:To study the long-term outcome of ketoconazole and tacrolimus combination in kidney transplant recipients.METHODS:From 2006 to 2010,ketoconazole was given in 199 patients and was continued for at least 1year or until graft failure(Group 1),while 149 patients did not receive any ketoconazole(Group 2).A combination of tacrolimus,mycophenolate and steroid was used as maintenance therapy.High risk patients received basiliximab induction.RESULTS:Basic demographic data was similar between the 2 groups.The 5-year cumulative incidence of biopsy-confirmed and clinically-treated acute rejection was significantly higher in Group 1 than in Group 2(34%vs 18%,P=0.01).The 5-year Kaplan-Meier estimated graft survival(74.3%vs 76.4%,P=0.58)and patient survival(87.8%vs 87.5%,P=0.93)were not differentbetween the 2 groups.Multivariable analyses identified ketoconazole usage as an independent risk of acute rejection(HR=2.33,95%CI:1.33-4.07;P=0.003)while tacrolimus dose in the 2nd month was protective(HR=0.89,95%CI:0.75-0.96;P=0.041).CONCLUSION:Co-administration of ketoconazole and tacrolimus is associated with significantly higher incidence of acute rejection in kidney transplant recipients.

Does the use of double hormone replacement therapy for trauma patient organ donors improve organ recovery for transplant

BACKGROUND With an ongoing demand for transplantable organs,optimization of donor management protocols,specifically in trauma populations,is important for obta-ining a high yield of viable organs per patient.Endocrine management of brain-dead potential organ donors(BPODs)is controversial,leading to heterogeneous clinical management approaches.Previous studies have shown that when levo-thyroxine was combined with other treatments,including steroids,vasopressin,and insulin,BPODs had better organ recovery and survival outcomes were increased for transplant recipients.AIM To determine if levothyroxine use in combination with steroids in BPODs increased the number of organs donated in trauma patients.METHODS A retrospective review of adult BPODs from a single level 1 trauma center over ten years was performed.Exclusion criteria included patients who were not solid organ donors,patients who were not declared brain dead(donation after circulatory death),and patients who did not receive steroids in their hospital course.Levothyroxine and steroid administration,the number of organs donated,the types of organs donated,and demographic information were recorded.Univariate analyses were performed with P<0.05 considered to be statistically significant.RESULTS A total of 88 patients met inclusion criteria,69(78%)of whom received levothyroxine and steroids(ST/LT group)vs 19(22%)receiving steroids without levothyroxine(ST group).No differences were observed between the groups for gender,race,pertinent injury factors,age,or other hormone therapies used(P>0.05).In the ST/LT group,68.1%(n=47)donated a high yield(3-5)of organ types per donor compared to 42.1%(n=8)in the ST group(P=0.038).There was no difference in the total number of organ types donated between the groups(P=0.068).CONCLUSION This study suggests that combining levothyroxine and steroid administration increases high-yield organ donation per donor in BPODs in the trauma patient population.Limitations to this study include the retrospective design and the relatively small number of organ donors who met inclusion criteria.This study is unique in that it mitigates steroid administration as a confounding variable and focuses specifically on the adjunctive use of levothyroxine.