tacrolimus and Ascites

We provide detailed analysis and outcomes in patients post-kidney transplant (KT) developing ascites, which has never been categorically reported.. Ascites was identified by ICD9/10 codes and detailed chart review in patients post-KT from 01/2004-06/2019. The incidence of patient death and graft loss were determined per 100-person-years, and the incidence rate ratio was obtained.. Of 3329 patients receiving KT, 83 (2.5%) patients had new-onset ascites, of whom 58% were male, 21% blacks, and 29% whites. Seventy-five percentage were on hemodialysis. Patients were maintained primarily on tacrolimus and mycophenolate for immunosuppression. Only 14% of patients with ascites had the appropriate diagnostic workup. There was a trend toward an increased mortality in patients with ascites (incidence rate ratio, IRR [95% CI]: 1.8 [0.92, 3.19], p = .06), and a significantly higher incidence of graft loss (IRR: 5.62 [3.97, 7.76], p < .001), compared with non-ascites patients. When classified by ascites severity, determined by imaging, moderate/severe ascites patients had the worst clinical outcomes, with a mortality of 32% and graft failure in 57%, compared with 9% and 10%, respectively, in those without ascites.. In this large cohort employing stepwise analysis of ascites post-KT, worse outcomes were noted, dictating the need for optimized management to improve clinical outcomes.

Topics: Ascites; Graft Rejection; Graft Survival; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Tacrolimus

Topics: Ascites; Humans; Immunosuppressive Agents; Kidney Transplantation; Tacrolimus

BACKGROUND Patients with massive ascites (MA) after liver transplantation (LT, defined here as daily ascitic drainage more than 1000 ml per day for more than 7 days after liver transplantation) are at increased risks of infection, hypoalbuminemia, graft loss, and even mortality. The aim of this retrospective cohort study was to investigate the effects of somatostatin on patients with MA after LT. MATERIAL AND METHODS Twenty-eight patients with liver cirrhosis or hepatocellular carcinoma who underwent LT complicated by MA postoperatively were included. Ten participants were receiving somatostatin therapy. The postoperative course and adverse drug effects were investigated. Daily postoperative ascitic drainage and urine output were also recorded and compared to those in the non-somatostatin group. RESULTS The somatostatin group had significantly less ascites drainage after LT compared to the non-somatostatin group (p=0.002). Urine output was significantly increased after somatostatin administration (p<0.001). No serious adverse effects influencing graft function or fatal complications occurred after somatostatin therapy. CONCLUSIONS Somatostatin treatment is beneficial for the management of MA after liver transplantation.

Topics: Adrenal Cortex Hormones; Adult; Aged; Ascites; Drug Therapy, Combination; Female; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Postoperative Complications; Retrospective Studies; Somatostatin; Tacrolimus; Treatment Outcome

Topics: Adult; Ascites; Chronic Disease; Cyclophosphamide; Female; Humans; Lupus Erythematosus, Systemic; Mycophenolic Acid; Peritonitis; Prednisolone; Severity of Illness Index; Tacrolimus; Tomography, X-Ray Computed; Treatment Outcome

A 57-year old male patient was admitted to our hospital because of severe vomiting and abdominal pain with massive ascites. He had been diagnosed as mixed connective tissue disease in 1997 and lupus nephritis ISN III (A/C) + V in 2003. Treatment was started with intravenous steroid pulse therapy combined with an immunosuppressant resulting in improvement of his proteinuria and serological activity. In 2008, the disease activity flared and he was admitted to our hospital with nephrotic syndrome. Hemodialysis was unavoidable, despite treatment with intravenous steroid pulse therapy and plasma exchange. We continued to treat him with oral prednisolone and tacrolimus. However, for personal reasons, he terminated tacrolimus treatment and massive ascites remained because of insufficient hemodialysis. Since the end of 2011, he suffered repeated abdominal pain with ileus and encapsulating peritoneal sclerosis (EPS) was detected. In February 2013, he underwent synechotomy for EPS. Here, we present a rare case of EPS in a hemodialysis patient.

Topics: Ascites; Chronic Disease; Digestive System Surgical Procedures; Humans; Ileus; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Lupus Nephritis; Male; Middle Aged; Mixed Connective Tissue Disease; Peritoneal Fibrosis; Prednisolone; Renal Dialysis; Tacrolimus; Tomography, X-Ray Computed

The Budd-Chiari syndrome (BCS) is characterized by hepatic venous outflow obstruction involving the hepatic veins, inferior vena cava, or both. BCS has occasionally been reported in the literature as a very rare complication of ulcerative colitis. However, association of Crohn's disease (CD) and BCS is extremely rare with only a single case reported in the world literature to date. We report a case of a young woman with chronically active, therapy-resistant CD who developed massive ascites, elevation of liver enzymes, and coagulopathy in the course of her disease. She was subsequently diagnosed with BCS for which a successful liver transplantation was performed. Chronically active therapy resistant CD and methylenetetrahydrofolate reductase gene mutation have been identified as possible risk factors for development of BCS in this patient.

Topics: Adrenal Cortex Hormones; Ascites; Budd-Chiari Syndrome; Crohn Disease; Female; Hepatic Veins; Humans; Immunosuppressive Agents; Liver; Liver Transplantation; Methylenetetrahydrofolate Reductase (NADPH2); Mutation; Phlebography; Risk Factors; Tacrolimus; Tomography, X-Ray Computed; Vena Cava, Inferior; Warfarin; Young Adult

The present study investigated the treatment effects of the immunosuppressive agent, tacrolimus (FK506), on rats with acute necrotizing pancreatitis (ANP).. We used the taurocholate-induced model of acute necrotizing pancreatitis (ANP) in rats that were divided into seven groups: The sham group included animals that underwent sham operations. The ANP group contained ANP rats induced by taurocholate. The tacrolimus groups contained ANP rats treated with tacrolimus at three different time points (prior to the induction of ANP, immediately after the induction of ANP, one hour after the induction of ANP). The somatostatin group included ANP rats treated with somatostatin. The glucocorticoids group contained ANP rats treated with glucocorticoids. At 3, 6 and 12 hours after the induction of taurocholate, blood samples were collected for TNF-alpha, IL-1beta and amylase assays, and lung and pancreas tissues were harvested for histopathological study and edema evaluation.. Tacrolimus administered prior to the induction of ANP and immediately after the induction of ANP caused a significant decrease in the twenty two-hour mortality rate (p<0.05). However, tacrolimus did not decrease the mortality rate when administered one hour after the induction of ANP (p>0.05). Treatment with all three drugs (tacrolimus, somatostatin and glucocorticoids) resulted in a significant decrease of serum amylase, lung edema, and serum TNF-alpha and IL-1beta levels. Pancreatic and pulmonary morphological alterations were improved.. Tancrolimus can decrease pancreatic and pulmonary injury. The effect of tacrolimus treatment is the same as that of somatostain and glucocroticoids. It is also more effective to administer the drug earlier.

Topics: Amylases; Animals; Anti-Inflammatory Agents; Ascites; Disease Models, Animal; Interleukin-1beta; Lung; Organ Size; Pancreas; Pancreatitis; Rats; Rats, Sprague-Dawley; Tacrolimus; Tumor Necrosis Factor-alpha

To examine the effects of ascites on tacrolimus disposition, the authors measured tacrolimus concentration in blood and ascitic fluid from a patient with a living related liver transplant recipient who required removal of 500 to 2400 mL ascitic fluid daily. Tacrolimus levels in ascitic fluid ranged from 0.07 to 0.29 ng/mL and in whole blood from 7.5 to 20.3 ng/mL. The tacrolimus concentration in ascitic fluid positively correlated with that in whole blood ( r = 0.878, P <0.0001). Because the amounts of tacrolimus excreted into the ascitic fluid corresponded to only 0.01% to 0.09% of the dose administered, the authors concluded that the effects of ascites on tacrolimus disposition were negligible even though large amounts of ascitic fluid were drained regularly.

Topics: Ascites; Humans; Immunosuppressive Agents; Infant; Liver Transplantation; Male; Tacrolimus

Five cases that were referred to the Division of Transplantation at NYU School of Medicine for consideration for liver transplantation were discussed among a panel of hepatitis B and liver transplant experts. Opinions were obtained on the management at every stage of treatment of patients with the following initial information: Case one: young Asian woman in stage IV hepatic coma; intubated; prothrombin time (PT): 30 s; serum glutamic oxaloacetic transaminase (SGOT): 8,000 IU; total bilirubin: 25 mg/dL; hepatitis B surface antigen (HBsAg) positive. Case two: 70-yr-old woman, native of Greece; decompensated cirrhosis with encephalopathy; Child-Pugh Class C; HBsAg positive; hepatitis B surface antibody (HBsAb) negative; hepatitis B e antigen (HBeAg) positive; hepatitis B e antibody (HBeAb) negative; hepatitis B virus (HBV) DNA titer: 10,000. Case three: Muscular detective working full-time; cirrhosis; Child Pugh Class B; ascites controlled with spironolactone and furosemide; PT: 19s; HBsAg positive; HBsAb negative; HBV DNA titer: 50,000; low platelet count. Case four: 45-yr-old baker; cirrhosis and resectable 4-cm hepatoma; Child-Pugh Class B; PT: 16 s; Blood type O; United Network for Organ Sharing (UNOS) 2B; HBV DNA titer: 3,000. Case five: 40-yr-old Indian man; 300 pounds with massive ascites; Child Pugh Class C; PT: 17 s; HBsAg positive; HBV DNA titer: 22,000; transplanted with intra-operative hypotension; tacrolimus; graft functioning; HBIg 10,000 IU intra-operative and around the clock during the first post-operative week; required huge doses of hepatitis B immune globulin (HBIg) to maintain adequate HBsAb level; daily loss of 5 6 L of ascites fluid; post-operative day 8: anuric, blood urea nitrogen (BUN) 127, creatinine 3, mental status changes.

Topics: Adult; Aged; Antiviral Agents; Ascites; Carcinoma, Hepatocellular; Female; Hepatic Encephalopathy; Hepatitis B; Humans; Immunization, Passive; Immunoglobulins; Immunosuppressive Agents; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Middle Aged; Tacrolimus