Predictors of improvement in renal function after calcineurin inhibitor withdrawal for post-liver transplant renal dysfunction.
BACKGROUND
Renal dysfunction after liver transplantation is a major management problem. Predictors of improvement in renal dysfunction after calcineurin inhibitor therapy (CNI) withdrawal and replacement with either mycophenolate mofetil (MMF) or azathioprine (AZA) have not previously been examined.


METHODS
Retrospective analysis of 33 post-transplant patients with creatinine clearance (CrCl) below 50 mL/min who were changed from CNI to either MMF or AZA. Following CNI withdrawal patients were divided into two groups: those with improved CrCl after switching and those without, to identify the variables associated with improved renal function.


RESULTS
Variables associated with improved CrCl were: absence of hypertension or diabetes, shorter time between transplantation and switch, deterioration in CrCl in months prior to switch and treatment with MMF (compared with AZA).


CONCLUSIONS
Our findings suggest CNI withdrawal should be targeted to a subgroup of patients whose renal function is most likely to improve.
Hong
Matthew Kh
MKh
Liver Transplant Unit, Austin Hospital, Melbourne, Vic., Australia.
Angus
Peter W
PW
Jones
Robert M
RM
Vaughan
Rhys B
RB
Gow
Paul J
PJ
D001379:Azathioprine / Q000627:therapeutic use; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood / Q000652:urine; D048909:Diabetes Complications; D004791:Enzyme Inhibitors / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006084:Graft Rejection / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D007168:IMP Dehydrogenase / Q000037:antagonists & inhibitors; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects / Q000378:metabolism; D007674:Kidney Diseases / Q000139:chemically induced / Q000503:physiopathology*; D016031:Liver Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011183:Postoperative Complications; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D016896:Treatment Outcome
D065095:Calcineurin Inhibitors; D004791:Enzyme Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D007168:IMP Dehydrogenase; D009173:Mycophenolic Acid; D001379:Azathioprine