title: Early use of renal-sparing agents in liver transplantation: a closer look.
abstract: Renal dysfunction is a critical issue for liver transplant candidates and recipients. Acute nephrotoxicity and chronic nephrotoxicity, however, are the compromises for the potent immunosuppression provided by calcineurin inhibitors (CNIs). To maintain the graft and patient survival afforded by CNIs while minimizing renal dysfunction in liver transplant patients, the reduction, delay, or elimination of CNIs in immunosuppression regimens is being implemented more frequently by clinicians. The void left by standard-dose CNIs is being filled by nonnephrotoxic immunosuppressants such as mycophenolates and mammalian target of rapamycin inhibitors. The results of studies of renal-sparing regimens in liver transplant recipients have been inconsistent, and this may be explained upon a closer examination of several study-related factors, including the study design and the duration of follow-up.
authors.affiliation: Baylor University Medical Center, Dallas, TX 75246, USA.
authors.forename: James F
authors.initials: JF
authors.lastname: Trotter
authors.forename: Monica
authors.initials: M
authors.lastname: Grafals
authors.forename: Angel E
authors.initials: AE
authors.lastname: Alsina
mesh_terms: D065095:Calcineurin Inhibitors; D002986:Clinical Trials as Topic; D004334:Drug Administration Schedule; D006801:Humans; D007165:Immunosuppression Therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D007668:Kidney / Q000187:drug effects*; D017093:Liver Failure / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives; D051437:Renal Insufficiency / Q000150:complications / Q000517:prevention & control*; D058570:TOR Serine-Threonine Kinases / Q000378:metabolism; D016559:Tacrolimus / Q000008:administration & dosage
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; C546842:MTOR protein, human; D058570:TOR Serine-Threonine Kinases; D009173:Mycophenolic Acid; D016559:Tacrolimus