title: Effect of low-dose tacrolimus with mycophenolate mofetil on renal function following liver transplantation.
abstract: OBJECTIVE
  To determine whether low-dose tacrolimus (TAC) combined with mycophenolate mofetil (MMF) is a safe approach to decrease the incidence of chronic kidney disease (CKD) in liver transplantation (LT) recipients.
  
  
  METHODS
  We analyzed the medical records of 689 patients who underwent LT between March 1999 and December 2012 in a single Chinese center. Immunosuppression was initiated with a calcineurin inhibitor (TAC or CSA) and prednisone with or without MMF. CKD is defined by the glomerular filtration rate (GFR), estimated by an abbreviated Modification of Diet in Renal Disease formula, < 60 mL/min per 1.73 m(2) for at least 3 consecutive months after LT. Individuals with TAC trough concentrations ≤ 8 ng/mL at 3 mo after LT were defined as the low-dose group. The incidence of CKD within 5 years was compared between the TAC group and the CSA group, as well as between four subgroups (low-dose and high-dose TAC groups with or without MMF).
  
  
  RESULTS
  No difference regarding the occurrence of pre-LT renal dysfunction or that of post-LT rejection was found between the TAC and CSA groups or between the four subgroups. With a definition of GFR < 60 mL/min per 1.73 m(2), the overall incidence of CKD was significantly higher in the CSA group than in the TAC group. The incidence of CKD in the low-dose TAC + MMF group (7.7%) was significantly lower than that observed in the low-dose TAC group (15.9%), high-dose TAC group (24.6%) and high-dose TAC + MMF group (18.5%). The cumulative 1-, 3- and 5-year incidence rates of CKD were 12.7%, 14.5% and 16.7%, respectively. The cumulative 5-year survival rates were 61.7% and 82.2% in patients with or without CKD, respectively.
  
  
  CONCLUSIONS
  In LT patients, the choice of immunosuppressive therapy appears to affect renal function and patient survival.
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jing-Cheng
authors.initials: JC
authors.lastname: Hao
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Wen-Tao
authors.initials: WT
authors.lastname: Wang
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Lu-Nan
authors.initials: LN
authors.lastname: Yan
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Bo
authors.initials: B
authors.lastname: Li
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Tian-Fu
authors.initials: TF
authors.lastname: Wen
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Jia-Yin
authors.initials: JY
authors.lastname: Yang
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ming-Qing
authors.initials: MQ
authors.lastname: Xu
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Ji-Chun
authors.initials: JC
authors.lastname: Zhao
authors.affiliation: Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
authors.forename: Yong-Gang
authors.initials: YG
authors.lastname: Wei
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D002681:China / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate / Q000187:drug effects; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000009:adverse effects; D015994:Incidence; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016559:Tacrolimus / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus
keywords: Calcineurin inhibitor; Chronic kidney disease; Liver transplantation; Mycophenolate mofetil