Limitations of current liver transplant immunosuppressive regimens: renal considerations

作     者：Wei Zhang John Fung 

作者机构：Department of Hepatobiliary Pancreatic SurgeryFirst Affiliated Hospital Zhejiang University School of Medicine Division of Transplant Surgery University of Chicago 

出 版 物：《Hepatobiliary & Pancreatic Diseases International》 (国际肝胆胰疾病杂志（英文版）)

年 卷 期：2017年第16卷第1期

页      面：27-32页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

主　　题：liver transplantation immunosuppression chronic kidney disease 

摘      要：BACKGROUND： The use of calcineurin inhibitor （CNI）-based immunosuppressive regimens following liver transplantation （LTx） has improved the outcomes of the recipients. However, CNI has nephrotoxicity and causes shortand long-term renal complications. The progressive structural changes can be irreversible in the long-term, leading to chronic kidney dysfunction. The present review was to evaluate the different strategies of CNI application to renal function in liver recipients. DATA SOURCES： PubMed database was searched for relevant articles in English on the issue of immunosuppressive regimen and kidney injury that related to early minimization of CNI after LTx. RESULTS： Total avoidance of CNI from post-LTx immunosuppressive regimens has been associated with unacceptable high rates of acute, steroid resistant rejections; late conversion from CNI to non-nephrotoxic immunosuppressant failed to recover renal function. Early CNI minimization and conversion to non-nephrotoxic immunosuppressant, although had no effect on patient survival rates, improved glomerular filtration rate. The combination of everolimus （a mammalian target of rapamycin inhibitor） and tacrolimus not only maintains immunosuppressive efficacy but also minimizes kidney injury. CONCLUSIONS： Up to now, protocols entirely avoiding CNI have not passed the primary safety endpoint of patient and graft survival, as well as the FDA mandated endpoint of biopsy proven acute rejection. Thus, early CNI minimization after LTx is the most rational approach preserving post-transplant renal function.