title: An analysis of tacrolimus-related complications in the first 30 days after liver transplantation.
abstract: OBJECTIVE
  Orthotopic liver transplantation has improved survival in patients with end-stage liver disease; however, therapeutic strategies that achieve ideal immunosuppression and avoid early complications are lacking. To correlate the dose and level of Tacrolimus with early complications, e.g., rejection, infection and renal impairment, after liver transplantation. From November 2011 to May 2013, 44 adult liver transplant recipients were studied in this retrospective comparative study.
  
  
  RESULTS
  The most frequent indication for liver transplantation was hepatitis C cirrhosis (47.7%), with a higher prevalence observed in male patients (68.18%). The ages of the subjects ranged from 19-71 and the median age was 55.5 years. The mean length of the hospital stay was 16.1±9.32 days and the mean Model for End-stage Liver Disease score was 26.18±4.28. There were five cases of acute cellular rejection (11.37%) and 16 cases of infection (36.37%). The blood samples that were collected and analyzed over time showed a significant correlation between the Tacrolimus blood level and the deterioration of glomerular filtration rate and serum creatinine (p<0.05). Patients with infections had a higher serum level of Tacrolimus (p = 0.012). The dose and presence of rejection were significantly different (p = 0.048) and the mean glomerular filtration rate was impaired in patients who underwent rejection compared with patients who did not undergo rejection (p = 0.0084).
  
  
  CONCLUSIONS
  Blood Tacrolimus levels greater than 10 ng/ml were correlated with impaired renal function. Doses greater than 0.15 mg/kg/day were associated with the prevention of acute cellular rejection but predisposed patients to infectious disease.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, São Paulo, SP, Brazil.
authors.forename: Lucas Souto
authors.initials: LS
authors.lastname: Nacif
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, São Paulo, SP, Brazil.
authors.forename: André Ibrahim
authors.initials: AI
authors.lastname: David
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, São Paulo, SP, Brazil.
authors.forename: Rafael Soares
authors.initials: RS
authors.lastname: Pinheiro
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, São Paulo, SP, Brazil.
authors.forename: Marcio Augusto
authors.initials: MA
authors.lastname: Diniz
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, São Paulo, SP, Brazil.
authors.forename: Wellington
authors.initials: W
authors.lastname: Andraus
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, São Paulo, SP, Brazil.
authors.forename: Ruy Jorge
authors.initials: RJ
authors.lastname: Cruz
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Department of Gastroenterology, Liver and Gastrointestinal Transplant Division, São Paulo, SP, Brazil.
authors.forename: Luiz A Carneiro
authors.initials: LA
authors.lastname: D'Albuquerque
mesh_terms: D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D005919:Glomerular Filtration Rate; D006084:Graft Rejection / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects*; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D007902:Length of Stay; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control; D018709:Statistics, Nonparametric; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus