title: The adverse pharmacology of calcineurin inhibitors and their impact on hepatitis C recurrence after liver transplantation: implications for clinical practice.
abstract: Calcineurin inhibitors are widely used as maintenance immunosuppressants in solid-organ transplantation to minimize the risk of allograft rejection. Although the use of these agents has transformed the outcomes for patient and graft survival, this has come at a cost, notably the well-known adverse events of nephrotoxicity and metabolic abnormalities, to name a few. Over the last decade, tremendous interest has also focused on the impact of these medications on the replication of hepatitis C virus (HCV), with cyclosporine in particular having a negative effect on viral replication in vitro. Although small retrospective studies suggested that there may be a beneficial effect with cyclosporine on the progression of recurrent HCV and response to interferon, these findings have not been validated in several well-designed randomized controlled trial studies. The authors will review the pharmacology and pharmacokinetics of these well-known drugs and discuss the impact of these medications on the natural history of HCV recurrence after liver transplantation.
authors.affiliation: 983285 Nebraska Medical Center, Division of Gastroenterology and Hepatology, Omaha, NE 68198-3285, USA.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Garcia-Saenz-de-Sicilia
authors.forename: Sandeep
authors.initials: S
authors.lastname: Mukherjee
mesh_terms: D065095:Calcineurin Inhibitors; D016572:Cyclosporine / Q000494:pharmacology; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D016174:Hepacivirus / Q000187:drug effects; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016031:Liver Transplantation; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D016572:Cyclosporine