title: [Case report of introducing MMF and steroids as an immunosuppressive therapy after living-donor liver transplantation for a patient with the diabetic nephropathy].
abstract: Calcineurin inhibitor (CNI) combined with mycophenolate mofetil (MMF) and steroid is mainly used as immunosuppressive therapy after the living-donor liver transplantation (LDLT). However, the nephrotoxicity caused by CNI remains a critical problem for patients with chronic renal failure, especially on early postoperative period. A 62-year-old woman with decompensated liver cirrhosis secondary to hepatitis B (Child-Pugh C, MELD score 11 points) and chronic renal failure due to diabetic nephropathy (Cr 1.56 mg/dl, GFR 27 ml/min/1.73 m2) experienced LDLT. During the reconstruction of hepatic vein, the supra-and infra-hepatic vena cava was totally clamped. The estimated right lobe liver graft volume was 540 g, representing 51.3% of the standard liver volume of the recipient. Because of the perioperative renal dysfunction due to diabetic nephropathy and the total clamping the vena cava which induced the congestion kidney, MMF (1500 mg/day) and steroid (250 mg/day converted into predonisolone) were mainly introduced as an immunosuppressive therapy after LDLT. The low-dose CNI, tacrolimus also induced the nephrotoxicity and was given for only a short time. Finally, according to the postoperative renal function, the low-dose CNI, cyclosporin (50 mg/day) was able to be added to the introduced immunosuppressive therapy. After having left the hospital, MMF (1500 mg/day), steroid (20 mg/day converted into predonisolone) and cyclosporin (75 mg/day) continued to be given as the immunosuppressive therapy and neither acute graft rejection nor drug-induced renal dysfunction was occurred. This is a case report of introducing with mainly MMF and steroid as an immunosuppressive therapy after LDLT for a patient with perioperative renal dysfunction.
authors.forename: Shotaro
authors.initials: S
authors.lastname: Kuramitsu
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Iguchi
authors.forename: Mizuki
authors.initials: M
authors.lastname: Ninomiya
authors.forename: Yo-ichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Norifumi
authors.initials: N
authors.lastname: Harimoto
authors.forename: Toru
authors.initials: T
authors.lastname: Ikegami
authors.forename: Hideaki
authors.initials: H
authors.lastname: Uchiyama
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Yoshizumi
authors.forename: Yuji
authors.initials: Y
authors.lastname: Soejima
authors.forename: Ken
authors.initials: K
authors.lastname: Shirabe
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kawanaka
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ikeda
authors.forename: Toshiya
authors.initials: T
authors.lastname: Furuta
authors.forename: Ryuichiro
authors.initials: R
authors.lastname: Tamada
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Maehara
mesh_terms: D016572:Cyclosporine / Q000008:administration & dosage / Q000009:adverse effects; D003928:Diabetic Nephropathies / Q000150:complications*; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007676:Kidney Failure, Chronic / Q000209:etiology; D008103:Liver Cirrhosis / Q000601:surgery; D016031:Liver Transplantation; D019520:Living Donors; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D011239:Prednisolone / Q000008:administration & dosage; D016559:Tacrolimus / Q000008:administration & dosage / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D011239:Prednisolone; D009173:Mycophenolic Acid; D016559:Tacrolimus