title: Calcineurin inhibitors in liver transplantation - still champions or threatened by serious competitors?
abstract: Current strategies for immunosuppression in liver transplant (LT) recipients include the design of protocols targeting a more individualized approach to reduce risk factors such as renal failure, cardiovascular complications and malignancies. Renal injury in LT recipients may be often multifactorial and is associated with increased risk of post-transplant morbidity and mortality. The quest for low toxicity immunosuppressive regimens has been challenging and resulted in CNI minimization protocols or CNI withdrawal and conversion to mycophenolate mofetil (MMF) and/or mammalian target of rapamycin inhibitor-based immunosuppressive regimens. Use of antibody induction to delay CNI administration may be an option in particular in immunocompromized, critically ill patients with high MELD scores. Protocols including MMF introduction and concomitant CNI minimization have the potential to recover renal function even in the medium and long term after LT. We review on hot topics in the prevention and management of acute and chronic renal injury in LT patients. For this purpose, we present and critically discuss results from immunosuppressive studies published in the current literature or presented at recent LT meetings.
authors: Department of Transplant Medicine, Muenster University Hospital, Muenster, Germany. susanne.beckebaum@ukmuenster.de
authors: Susanne
authors: S
authors: Beckebaum
authors: Vito R
authors: VR
authors: Cicinnati
authors: Arnold
authors: A
authors: Radtke
authors: Iyad
authors: I
authors: Kabar
mesh_terms: D000069594:Abatacept; D065095:Calcineurin Inhibitors; D000068338:Everolimus; D006801:Humans; D018796:Immunoconjugates / Q000276:immunology / Q000494:pharmacology; D007165:Immunosuppression Therapy / Q000379:methods*; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000276:immunology / Q000494:pharmacology; D057285:Precision Medicine / Q000379:methods*; D011758:Pyrroles / Q000276:immunology / Q000494:pharmacology; D011799:Quinazolines / Q000276:immunology / Q000494:pharmacology; D051437:Renal Insufficiency / Q000209:etiology / Q000517:prevention & control*; D012307:Risk Factors; D020123:Sirolimus / Q000031:analogs & derivatives / Q000276:immunology / Q000494:pharmacology; D058570:TOR Serine-Threonine Kinases / Q000276:immunology; D016559:Tacrolimus / Q000276:immunology / Q000494:pharmacology
chemical_list: D065095:Calcineurin Inhibitors; D018796:Immunoconjugates; D011758:Pyrroles; D011799:Quinazolines; D000069594:Abatacept; C543528:sotrastaurin; D000068338:Everolimus; D058570:TOR Serine-Threonine Kinases; D009173:Mycophenolic Acid; D020123:Sirolimus; D016559:Tacrolimus