Ann Hepatobiliary Pancreat Surg.  2018 Feb;22(1):19-26. 10.14701/ahbps.2018.22.1.19.

A cross-sectional analysis of long-term immunosuppressive regimens after liver transplantation at Asan Medical Center: Increased preference for mycophenolate mofetil

• Hwang S
• Ahn CS
• Kim KH
• Moon DB
• Ha TY
• Song GW
• Jung DH
• Park GC
• Lee SG

• KMID: 2409076
• DOI: http://doi.org/10.14701/ahbps.2018.22.1.19

Abstract

BACKGROUNDS/AIMS
Long-term immunosuppression regimens after liver transplantation (LT) are rarely reported in detail. We aimed to provide information on actual long-term immunosuppression regimens through this cross-sectional study.
METHODS
Our institutional LT database was searched for adult patients who underwent primary LT operation from 2000 to 2016. We identified 3620 live recipients with actual information on immunosuppressive agent use for 1-17 years.
RESULTS
The study cohort was divided into 7 groups according to posttransplantation period. The immunosuppressive agents used at the cross-sectional review period were tacrolimus in 2884 (79.7%), cyclosporine in 445 (12.3%), mycophenolate mofetil in 2007 (55.4%), and everolimus in 138 (3.8%) recipients. There was no marked difference in immunosuppressive agent use according to pretransplantation liver malignancy or type of LT operation. Tacrolimus, cyclosporine, mycophenolate mofetil, and everolimus were used in 97.4%, 1.8%, 60.9%, and 9.2%, respectively, in the year 2 group; 94.1%, 3.9%, 51.6%, and 8.3%, respectively, in the year 3 group; 87.3%, 8.4%, 68.9%, and 4.8%, respectively, in the year 4-5 group; 78.2%, 12.9%, 64.6%, and 3.0%, respectively, in the year 6-7 group; 76.9%, 10.8%, 58.8%, and 2.4%, respectively, in the year 8-10 group; 66.7%, 22.4%, 43.4%, and 1.5%, respectively, in the year 11-15 group; and 73.8%, 15.4%, 32.9%, and 1.7%, respectively, in the year ≥15 group.
CONCLUSIONS
Tacrolimus and mycophenolate mofetil are the primary immunosuppressive agents after LT, and the indications for everolimus have started to increase at our institution. We believe our results will help establish tailored long-term immunosuppression regimens.

Keyword

Tacrolimus; Mycophenolate mofetil; Everolimus; Malignancy; Hepatocellular carcinoma

MeSH Terms

Adult
Carcinoma, Hepatocellular
Chungcheongnam-do*
Cohort Studies
Cross-Sectional Studies*
Cyclosporine
Everolimus
Humans
Immunosuppression
Immunosuppressive Agents
Liver Transplantation*
Liver*
Tacrolimus
Cyclosporine
Everolimus
Immunosuppressive Agents
Tacrolimus

Figure

• 

  Fig. 1 Proportions of immunosuppressive regimens in 3620 liver transplant recipients. C, cyclosporine; M, mycophenolate mofetil; F, tacrolimus; T, everolimus. Combination of these capital letters indicates combination therapy.

• 

  Fig. 2 Changes in immunosuppressive regimens relative to posttransplantation period. C, cyclosporine; M, mycophenolate mofetil; F, tacrolimus; T, everolimus. Combination of these capital letters indicates combination therapy.

• 

  Fig. 3 Proportions of immunosuppressive regimens in liver transplant recipients with or without pretransplantation liver malignancy. C, cyclosporine; M, mycophenolate mofetil; F, tacrolimus; T, everolimus. Combination of these capital letters indicates combination therapy.

• 

  Fig. 4 Proportions of immunosuppressive regimens in deceased-donor and living-donor liver transplantation (LT) recipients. C, cyclosporine; M, mycophenolate mofetil; F, tacrolimus; T, everolimus. Combination of these capital letters indicates combination therapy.

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