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Randomized Trial of Ciclosporin with 2-h Monitoring vs. Tacrolimus with Trough Monitoring in Liver Transplantation: DELTA Study. | LitMetric

AI Article Synopsis

  • Previous studies on cyclosporine and tacrolimus for liver transplant outcomes have yielded mixed results, often using less precise dosing methods.
  • A recent trial compared the effectiveness of 2-hour monitoring (C2) with trough level monitoring (T0) of these drugs, focusing on rates of acute rejection and patient survival.
  • Results showed that T0 significantly reduced both biopsy-proven acute rejection and mortality rates compared to C2 in the first year post-transplant, indicating better overall outcomes with T0.

Article Abstract

Background And Aims: Previous trials comparing cyclosporine and tacrolimus after liver transplantation (LT) showed conflicting results. Most used trough monitoring for cyclosporine (C0), leading to less accurate dosing than with 2-h monitoring (C2). Only one larger trial compared C2 with tacrolimus based on trough level (T0) after LT, with similar treated biopsy-proven acute rejection (tBPAR) and graft loss, while a smaller trial had less tBPAR with C2 compared to T0. Therefore, it is still unclear which calcineurin inhibitor is preferred after LT. We aimed to demonstrate superior efficacy (tBPAR), tolerability, and safety of C2 or T0 after first LT.

Methods: Patients after first LT were randomized to C2 or T0. tBPAR, patient- and graft survival, safety and tolerability were the main endpoints, with analysis by Fisher test, Kaplan-Meier survival analysis and log-rank test.

Results: In intention-to-treat analysis 84 patients on C2 and 85 on T0 were included. Cumulative incidence of tBPAR C2 vs. T0 was 17.7% vs. 8.4% at 3 months (=0.104), and 21.9% vs. 9.7% at 6 and 12 months (=0.049). One-year cumulative mortality C2 vs. T0 was 15.5% vs. 5.9% (=0.049) and graft loss 23.8% vs. 9.4% (=0.015). Serum triglyceride and LDL-cholesterol was lower with T0 than with C2. Incidence of diarrhea in T0 vs, C2 was 64% vs. 31% (≤0.001), with no other differences in safety and tolerability.

Conclusions: In the first year after LT immunosuppression with T0 leads to less tBPAR and better patient-/re-transplant-free survival as compared to C2.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10318291PMC
http://dx.doi.org/10.14218/JCTH.2022.00348DOI Listing

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