title: Long-term renal function deteriorates at a similar rate among liver transplant patients with preserved renal function at 1 year and in the general population: is chronic calcineurin inhibitor nephrotoxicity overrated?
abstract: BACKGROUND
  Chronic calcineurin inhibitor (CNI) nephrotoxicity is associated with histologic kidney lesions, but the contribution of maintenance-dose CNI use to the decline over time in glomerular filtration rate (GFR) post liver transplantation (OLT) remains unclear.
  
  
  METHODS
  We studied annual changes in estimated GFR >1 year posttransplant among 105 CNI-treated adult OLT patients with a GFR of 60-100 mL/min at 1 year during a mean follow-up of 7 years (20 years in 20 patients).
  
  
  RESULTS
  The annual GFR decline >1 year posttransplant was 0.2 mL/min per year (SD 3.8). This decline rate was unaffected by the decade of OLT, follow-up period, or GFR at 1 year, and showed no correlation with CNI blood levels. Of the 13 (12%) patients with a GFR deterioration >3 mL/min per year, 77% presented with hypertension, diabetes, and/or dyslipidemia. The decline in GFR >1 year post-OLT did not exceed the decline of 0.5-0.8 mL/min per year reported in the general population. Declines faster than 3 mL/min per year, which occurred no more frequently among patients than in the general population, seemed attributable to coexistent vascular risk factors.
  
  
  CONCLUSIONS
  Among OLT patients with preserved renal function at 1 year posttransplant, our findings challenge the clinical impact of chronic progressive CNI nephrotoxicity and highlight the importance of a tight control of blood pressures, glucose and lipid levels, and other modifiable risk factors in order to preserve long-term renal function.
authors.affiliation: Transplantation and Liver Surgery Clinic, Helsinki University Hospital, Helsinki, Finland. Fredrik.Aberg@helsinki.fi
authors.forename: F
authors.initials: F
authors.lastname: Aberg
authors.forename: H
authors.initials: H
authors.lastname: Mäkisalo
authors.forename: A
authors.initials: A
authors.lastname: Nordin
authors.forename: H
authors.initials: H
authors.lastname: Isoniemi
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents