Immunosuppression effect on the activity of enzymes of liver function assessment after kidney transplantation in a university hospital in Fortaleza

Abstract

Objective: this study aimed to evaluate changes in liver enzymes in kidney transplant patients under two different immunosuppressive regimens. Methods: a retrospective study was conducted with 186 patients who underwent kidney transplantation between 2019 and 2023 at the Walter Cantídio University Hospital (HUWC). Patients were divided into two groups, according to the immunosuppressive regimen used: Tacrolimus and Mycophenolate Sodium (TAC+MDS) and Tacrolimus and Sirolimus (TAC+SRL). The activities of the enzymes alanine transaminase (ALT), aspartate transaminase (AST) and gamma-glutamyl transferase (GGT) were analyzed and categorized according to the profile of the elevation above the reference value. Results: both immunosuppression groups presented more than 50% of cases of increases in liver function parameters, though it was not found to be statistically significant. Only the TAC+SRL group showed significant elevations in GGT levels (p = 0.038; OR = 9.75; 95% CI = 0.531 - 179), indicating a potential greater hepatotoxicity associated with the TAC+SRL regimen. Conclusion: immunosuppression regimens are associated with subclinical elevation of liver enzymes, with no significant difference between them. However, the combination of Tacrolimus and Sirolimus is associated with a more severe elevation of the liver enzyme GGT, but the large variability in the confidence interval suggests a low precision analysis due to the small sample, requiring more robust analyses to confirm this suspicion of an increased risk of hepatotoxicity. These findings highlight the importance of rigorous and continuous monitoring of liver function in patients receiving this regimen after kidney transplantation, with a view to facilitating early detection and appropriate management of liver complications.