Renal function after liver transplantation: calcineurin inhibitor nephrotoxicity

Ziółkowski, Jerzy; Pączek, Leszek; Senatorski, G; Niewczas, Monika A.; Ołdakowska‐Jedynak, Urszula; Wyzgał, Janusz; Sańko-Resmer, Joanna; Pilecki, Tomasz; Zieniewicz, Krzysztof; Nyckowski, P; Patkowski, Waldemar; Krawczyk, Marek

doi:10.1016/s0041-1345(03)00786-3

Cited by 38 publications

(25 citation statements)

References 11 publications

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“…Renal dysfunction is common after liver transplantation [22][23][24][25] , and it has been reported to be associated with high levels of CNI [26] . ADV contributed to the elevation of plasma tacrolimus levels in this patient, and this elevation may have been associated with his renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Minemura

Tokimitsu²,

Tajiri³

et al. 2010

WJH

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We report the case of a patient treated with living do norrelated liver transplantation who suffered from osteomalacia during adefovir dipivoxil (ADV)containing antiviral therapy for lamivudineresistant hepatitis B virus infection. The patient had generalized bone pain, with severe hypophosphatemia after 20 mo of ADV therapy. Radiographic studies demonstrated the presence of osteomalacia. The peak plasma ADV level was 38 ng/mL after administration of ADV at 10mg/day. It was also found that ADV affected the metabolism of tacrolimus, a calcineurininhibitor, and caused an increase in the plasma levels of tacrolimus. The disability was reversed with the withdrawal of ADV and with mineral supplementation. ADV can cause an elevation of plasma tacrolimus levels, which may be associated with renal dysfunction. High levels of ADV and tacrolimus can cause nephrotoxicity and osteomalacia. This case highlights the importance of considering a diagnosis of osteomalacia in liver transplantation recipients treated with both ADV and tacrolimus.

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Section: Discussionmentioning

confidence: 99%

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Minemura

Tokimitsu²,

Tajiri³

et al. 2010

WJH

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“…Conversion to sirolimus led to an improvement in renal function in about a half of the patients, on average more than 6 months after the switch [79]. It has been used either as a monotherapy [80] or together with low-dose tacrolimus, resulting in exceptionally low rates of acute rejection, and continued, excellent renal function [81][82][83]. In several experiences MMF and azathioprine both made safe withdrawal of CsA or tacrolimus possible [84][85][86].…”

Section: Organ-specific Reportsmentioning

confidence: 99%

Posttransplantation chronic renal damage in nonrenal transplant recipients

Stratta¹,

Canavese²,

Quaglia³

et al. 2005

Kidney International

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Calcineurin inhibitor-induced nephrotoxicity is a growing problem and, as the age of recipients of nonrenal organs is increasing, this problem is destined to increase. It would therefore be advisable for nephrologists to share their experiences in immunomodulation with other specialties, so as to favor the cautious extension of calcineurin inhibitor-sparing protocols to the area of life-saving transplants.

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“…Although the cause of renal dysfunction after liver transplant is likely to be multifactorial, there is evidence that the prolonged use of both tacrolimus and cyclosporine contributes to renal insufficiency and to end-stage renal disease. [2][3][4] Thirteen years after transplant, severe renal dysfunction occurred in 18.1% of liver transplant recipients receiving CNI-based immunosuppression, and 9.5% needed hemodialysis. 5 Long-term survival of patients with end-stage renal disease requiring hemodialysis therapy is low, with a reported survival rate of only 27% at 6 years.…”

Section: Introductionmentioning

confidence: 99%

Long-term Outcome of Conversion to Sirolimus Monotherapy After Liver Transplant

Uhlmann

Weber²,

Ludwig³

et al. 2012

Exp Clin Transplant

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Objectives: This study sought to assess the longterm efficacy and safety of conversion from a calcineurin inhibitor-based immunosuppressive regimen to sirolimus monotherapy in liver transplant recipients with renal dysfunction. Materials and Methods: Twenty-five liver transplant recipients with calcineurin inhibitor-based immunosuppression were included in this singlecenter, prospective study. Indications were renal dysfunction, avoidance of tumor recurrence, combination renal dysfunction and avoidance of tumor recurrence, and calcineurin inhibitor-related adverse effects. Results: Mean interval between liver transplant and initiation of sirolimus monotherapy was 51.7 months. The mean follow-up was 75.6 months. The mean ± SD sirolimus whole-blood trough level was 9.0 ± 2.8 ng/mL after 6 months and 6.0 ± 1.8 ng/mL after 18 months. No rejection episode occurred. There was an improvement of the mean creatinine level: 156.1 ± 54.9 µmol/L before conversion versus 129.1 ± 34.7 µmol/L approximately 3 years after conversion (P < .05). The glomerular filtration rate, measured by technetium Tc-99m-diethylenetriamine penta acetic aerosol scintigraphy, improved from 27.4 ± 6.8 mL/min/1.73 m 2 before conversion to 43.3 ± 6.3 mL/min/1.73 m 2 at final follow-up. Proteinuria increased after conversion to sirolimus after 6 months (P < .05) and at last follow-up. The systolic blood pressure decreased from 151.5 ± 20.2 to 132.1 ± 19.4 mm Hg, and the diastolic from 89.7 ± 11.2 to 82.1 ± 9.1 mm Hg at last followup. Serum cholesterol and serum triglyceride levels were nearly unchanged. However, 50% of the patients were treated with lipid-lowering agents. Four patients had sirolimus-induced adverse effects (thrombocytopenia, gingival hyperplasia, oral ulceration). Conclusions: Conversion from calcineurin inhibitors to sirolimus monotherapy after liver transplant results in stabilization of renal function in 75% to 85% of cases and of blood pressure, without increased risk of rejection. The spectrum of adverse effects is low.

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Renal function after liver transplantation: calcineurin inhibitor nephrotoxicity

Cited by 38 publications

References 11 publications

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Development of osteomalacia in a post-liver transplant patient receiving adefovir dipivoxil

Posttransplantation chronic renal damage in nonrenal transplant recipients

Long-term Outcome of Conversion to Sirolimus Monotherapy After Liver Transplant

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