title: Tacrolimus for primary liver transplantation: 12 to 15 years actual follow-up with safety profile.
abstract: BACKGROUND
  Tacrolimus has been increasingly used for liver transplantation during the last decade. The drug has immunological advantages in short- to medium-term follow-up. However, data on longitudinal follow-up are lacking.
  
  
  OBJECTIVE
  The aim of the present report was to examine the impact of tacrolimus in primary adult and pediatric liver transplantation (LTx) patients.
  
  
  METHODS
  One thousand consecutive primary LTx patients were performed under tacrolimus between August 1989 and December 1992 were followed up until August 2004. Mean follow-up was 13.4 +/- 0.92 (range, 11.7-15) years. There were 600 males and 400 females with a mean age of 42.6 +/- 20.2 years. There were 166 children (age 18 years or younger) and 834 adults, of whom 204 were older than 60 years (seniors).
  
  
  RESULTS
  Four hundred ninety-seven (49.7%) patients died in the follow-up period. The overall 15-year actuarial patient survival rate was 51.4%. The survival rate for children was significantly better (81.3%) compared with adults (47.5%) and seniors (36.4%) (P = .0001). One hundred fifty-one patients received a second LTx, 22 patients received a third LTx, and 4 patients received a fourth LTx. Over all 15 years the actuarial graft survival rate was 46.1%. At last follow-up, 69.1% of patients were off steroids. The majority of late deaths were due to age-related complications, recurrence of disease, and De novo cancers.
  
  
  CONCLUSIONS
  The data on longitudinal follow-up have shown actuarial survival for children to be significantly better than in adults and seniors. Graft loss from immunological causes are rare even with long-term follow-up.
authors.affiliation: Strong Memorial Hospital, Department of Surgery, Transplant Division, University of Rochester, Rochester, NY 14642, USA. Ashok_jain@urmc.Rochester.edu
authors.forename: A
authors.initials: A
authors.lastname: Jain
authors.forename: A
authors.initials: A
authors.lastname: Marcos
authors.forename: J
authors.initials: J
authors.lastname: Reyes
authors.forename: G
authors.initials: G
authors.lastname: Mazariagos
authors.forename: R
authors.initials: R
authors.lastname: Kashyap
authors.forename: B
authors.initials: B
authors.lastname: Eghtesad
authors.forename: W
authors.initials: W
authors.lastname: Marsh
authors.forename: P
authors.initials: P
authors.lastname: Fontas
authors.forename: M
authors.initials: M
authors.lastname: De Vera
authors.forename: G
authors.initials: G
authors.lastname: Costa
authors.forename: K
authors.initials: K
authors.lastname: Patel
authors.forename: M
authors.initials: M
authors.lastname: Gadomski
authors.forename: T
authors.initials: T
authors.lastname: Starzl
authors.forename: J
authors.initials: J
authors.lastname: Fung
mesh_terms: D000328:Adult; D002423:Cause of Death; D002648:Child; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000276:immunology* / Q000401:mortality; D008875:Middle Aged; D012189:Retrospective Studies; D012449:Safety; D016019:Survival Analysis; D016559:Tacrolimus / Q000627:therapeutic use*; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016559:Tacrolimus