Renal failure after liver transplantation: outcome after calcineurin inhibitor withdrawal.
Chronic nephrotoxicity is one of the most serious side-effects of calcineurin inhibitor treatment and a factor in mortality and morbidity after liver transplantation. In our transplant centre, among patients who underwent a liver transplantation between January 1989 and December 2000, 14 liver graft recipients (6.86%) developed de novo severe renal dysfunction as defined by a serum creatinine concentration above 200 micromol/L. Renal biopsy was performed in nine cases and evidenced histological lesions compatible with chronic nephrotoxicity related to calcineurin inhibitor treatment. For nine patients, we report the results of a prospective non-randomized study consisting of cyclosporine or tacrolimus withdrawal associated with administration of mycophenolate mofetil or azathioprine. Despite this therapeutic modification, we did not observe a significant renal function improvement but on the other hand, there was no graft rejection.
Neau-Cransac
Martine
M
Liver Transplantation Unit, Pellegrin Hospital, Bordeaux Cedex, France. martine.neau-cransac@chu-bordeaux.fr
Morel
Delphine
D
Bernard
Pierre-Henri
PH
Merville
Pierre
P
Revel
Philippe
P
Potaux
Luc
L
Saric
Jean
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D001379:Azathioprine / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D002648:Child; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D007168:IMP Dehydrogenase / Q000037:antagonists & inhibitors; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D016559:Tacrolimus / Q000627:therapeutic use
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D007168:IMP Dehydrogenase; D009173:Mycophenolic Acid; D001379:Azathioprine; D016559:Tacrolimus