Acute Renal Failure Requiring Dialysis in Liver Transplant Recipients under Tacrolimus, Prednisone vs Tacrolimus, Prednisone and Cellcept

779 Acute renal failure requiring dialysis after transplantation has been associated with very high mortality rates. We have reported a mortality rate of 90% in a small study of patients transplanted under cyclosporine between 1983 and 1985. A more optimistic patient survival was suggested by our clinical experience. We later found that patient survival was approximately 45% in a subsequent study with cyclosporine treated patients. We now report the influence of the need for dialysis on patient survival in a randomized trial of double (Tacrolimus, Prednisone) versus triple (Tacrolimus, Prednisone, and Cellcept) in liver transplant recipients from August 1995 to May of 1998. Three hundred patients were enrolled; 151 received double and 149 triple therapy. One year patient survival was 84% for double and 85.9% in triple therapy patients overall (p=0.81). Dialysis support was required in 57 (19%) of all patients. One year patient survival for those not requiring dialysis was 92.1%, 65.6% for those requiring Hemodialysis (HD), and 40% for SCUF treated patients (p < 0.001). HD was required in 17 (11.3%) double and 15 (10.1%) triple patients; SCUF was required in 16 (10.6%) double and 9 (6%) triple therapy. In the double group 33 (21.9%) and triple 24(16.1%) patients required dialysis (p=0.2). Patient survival was 93.2%, 58.8% and 43.8% for double patients without HD, HD treatment, and SCUF treatment respectively; for triple patients survival was 91.2%, 73.3% and 33% respectively (p < 0.001). There was no difference in patient survival between double or triple therapy in the dialysis subgroups. In summary, acute renal failure requiring dialysis is a major determinant of patient survival. The early reports of extremely poor results in this group are not supported by our present results. It is also possible that survival in these patients is improving due to changes in patient care. We could find no advantage for triple therapy in this study however.