{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T03:42:50Z","timestamp":1768880570563,"version":"3.49.0"},"reference-count":23,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2022,1,15]],"date-time":"2022-01-15T00:00:00Z","timestamp":1642204800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Transplantation for patients with acute\u2010on\u2010chronic liver failure grade 3 (ACLF3) has encouraging results with 1\u2010year\u2010survival of 80\u201090%. These patients with multiple organ failure meet the conditions for serious alterations of drug metabolism and increased toxicity. The goal of this study was to identify immunosuppression\u2010dependent factors that affect survival. This retrospective monocentric study was conducted in patients with ACLF3 consecutively transplanted between 2007 and 2019. The primary endpoint was 1\u2010year survival. Secondary endpoints were overall survival, treated rejection, and surgical complications. Immunosuppression was evaluated as to type of immunosuppression, post\u2010transplant introduction timing, trough levels, and trough level intra\u2010patient variability (IPV). One hundred patients were included. Tacrolimus IPV\u00a0&lt;\u00a040% (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.019), absence of early tacrolimus overdose (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.033), use of anti\u2010IL2\u2010receptor antibodies (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.034), and early mycophenolic acid introduction (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.038) predicted 1\u2010year survival. Treated rejection was an independent predictor of survival (<jats:italic>P<\/jats:italic>\u00a0=\u00a0.001; HR 4.2 (CI 95%: 1.13\u201015.6)). Early everolimus introduction was neither associated with higher rejection rates nor with more surgical complications. Management of immunosuppression in ACLF3 critically ill patients undergoing liver transplantation is challenging. Occurrence and treatment of rejection impacts on survival. Early introduction of mTOR inhibitor seems safe and efficient in this situation.<\/jats:p>","DOI":"10.1111\/ctr.14580","type":"journal-article","created":{"date-parts":[[2022,1,2]],"date-time":"2022-01-02T13:58:27Z","timestamp":1641131907000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Immunosuppression in patients with grade 3 acute\u2010on\u2010chronic liver failure at transplantation: A practice analysis study"],"prefix":"10.1111","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6514-0774","authenticated-orcid":false,"given":"Francois","family":"Faitot","sequence":"first","affiliation":[{"name":"Hepatobiliopancreatic Surgery and Transplantation Department Hopital de Hautepierre Hopitaux Universitaires de Strasbourg  Strasbourg France"},{"name":"Laboratoire ICube UMR7357 University of Strasbourg  Strasbourg 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Intensive\u2010Reanimation Hopital de Hautepierre Hopitaux Universitaires de Strasbourg  Strasbourg France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jean\u2010Etienne","family":"Herbrecht","sequence":"additional","affiliation":[{"name":"Medecine Intensive\u2010Reanimation Hopital de Hautepierre Hopitaux Universitaires de Strasbourg  Strasbourg France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ralf","family":"Janssen Langenstein","sequence":"additional","affiliation":[{"name":"Medecine Intensive\u2010Reanimation Hopital de Hautepierre Hopitaux Universitaires de Strasbourg  Strasbourg France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Quentin","family":"Maestraggi","sequence":"additional","affiliation":[{"name":"Medecine Intensive\u2010Reanimation Hopital de Hautepierre Hopitaux Universitaires de Strasbourg  Strasbourg 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