Renal failure after liver transplantation: outcome after calcineurin inhibitor withdrawal

Clin Transplant. 2002 Oct;16(5):368-73. doi: 10.1034/j.1399-0012.2002.02028.x.

Abstract

Chronic nephrotoxicity is one of the most serious side-effects of calcineurin inhibitor treatment and a factor in mortality and morbidity after liver transplantation. In our transplant centre, among patients who underwent a liver transplantation between January 1989 and December 2000, 14 liver graft recipients (6.86%) developed de novo severe renal dysfunction as defined by a serum creatinine concentration above 200 micromol/L. Renal biopsy was performed in nine cases and evidenced histological lesions compatible with chronic nephrotoxicity related to calcineurin inhibitor treatment. For nine patients, we report the results of a prospective non-randomized study consisting of cyclosporine or tacrolimus withdrawal associated with administration of mycophenolate mofetil or azathioprine. Despite this therapeutic modification, we did not observe a significant renal function improvement but on the other hand, there was no graft rejection.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Azathioprine / therapeutic use
  • Calcineurin Inhibitors*
  • Child
  • Creatinine / blood
  • Female
  • Humans
  • IMP Dehydrogenase / antagonists & inhibitors
  • Immunosuppressive Agents / therapeutic use
  • Liver Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Mycophenolic Acid / analogs & derivatives*
  • Mycophenolic Acid / therapeutic use
  • Renal Insufficiency / blood
  • Renal Insufficiency / chemically induced*
  • Renal Insufficiency / pathology
  • Tacrolimus / therapeutic use

Substances

  • Calcineurin Inhibitors
  • Immunosuppressive Agents
  • Creatinine
  • IMP Dehydrogenase
  • Mycophenolic Acid
  • Azathioprine
  • Tacrolimus