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Updated: Aug 27, 2026
Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
Published on: November 8, 2015
A randomized prospective study of tacrolimus-sparing basiliximab induction with delayed everolimus addition in
Reghan L Conrey1, Ryan Ma, Minah Ha
1Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, California, USA.
Abstract:
Calcineurin inhibitors (CNIs) remain the cornerstone of immunosuppression after liver transplantation (LT) but contribute to chronic renal failure, increasing long-term morbidity and mortality. Strategies to minimize CNI exposure and preserve renal function are necessary to improve long-term outcomes in high-acuity LT recipients. We conducted a single-center, prospective, randomized trial of adult LT recipients requiring pre-LT renal replacement therapy (RRT). Patients were randomized to: (1) basiliximab induction and delayed tacrolimus starting postoperative day (POD) 5 (BAS); (2) basiliximab induction, tacrolimus starting POD5, and everolimus starting POD31, followed by tacrolimus minimization (BAS-EVR); (3) standard immunosuppression (control). RRT independence, renal function, rejection, graft and patient survival, and adverse events were assessed. Seventy patients were analyzed (BAS n=30; BAS-EVR n=28; control n=12). Median MELD was 40, and 55.7% of patients required mechanical ventilation or vasopressor support pre-LT. Overall, 68.6% of patients achieved RRT independence by 24 weeks: 73.3% (BAS), 75.0% (BAS-EVR), and 41.7% (control). Basiliximab ( p =0.04) and shorter duration of pre-LT RRT ( p =0.02) were significantly associated with RRT independence; basiliximab remained significant after adjusting for duration of pre-LT RRT [OR 3.87 (95% CI 1.01-14.74), p =0.048]. Among patients who achieved RRT independence, median eGFR trended higher in the BAS-EVR group (67 mL/min/1.73 m 2 ) than in BAS (52 mL/min/1.73 m 2 ) and control groups (50 mL/min/1.73 m 2 ) at 24 weeks. Patient and graft survival were comparable across groups. Adverse events were similar, although diarrhea ( p =0.004) and acute kidney injury ( p =0.01) were more frequent in the BAS-EVR group. Basiliximab induction therapy with delayed tacrolimus promotes RRT independence in high-acuity LT recipients. Addition of everolimus to minimize tacrolimus may further preserve renal function without compromising graft or patient survival.
