Early serum tacrolimus levels predict long-term chronic kidney disease after liver transplantation

Brandão, Vanessa B. A.; Faria, Luciana Costa; Bicalho, Danielle M.; Pereira, Fernando Henrique; Lima, Agnaldo Soares; Ferrari, Teresa C. A.

doi:10.5935/medicalexpress.2014.03.09

Cited by 1 publication

(1 citation statement)

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“…This was comparable to other studies; for instance in a study by Utsumi et al [20] from Japan, preoperative diabetes and over exposure to calcineurin inhibitors were risk factors for post-transplant renal dysfunction. Likewise, in the study by Brandao et al [35] from Brazil, male gender and median tacrolimus levels (11.3 µg/l) in the first 3 mo of post LT were significant risk factors whilst pretransplant serum creatinine (>1.2 mg/dl) was cited as the important determinant of post LDLT renal dysfunction in the study by Ling et al [36] from China and Pawarode et al [4] from USA.…”

Section: Resultsmentioning

confidence: 98%

Evaluation of Factors Influencing Renal Dysfunction Following Living Donor Liver Transplantation

Sunny¹,

James²,

Krishnapriya³

et al. 2016

IJPS

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Deterioration of kidney function is the most worrisome long term complication following liver transplantation. This study was performed to identify the risk factors of renal dysfunction following living donor liver transplant and the effect of immunosuppressant dosage adjustment on the recovery of renal function. A retrospective observational study was conducted on 133 consecutive adult living donor liver transplant recipients over an 8 y period from 2006 onwards. An increase in serum creatinine of >1.4 mg/dl was taken as a marker for renal insufficiency. The incidence of post living donor liver transplant renal dysfunction was 35% and maximum incidence occurred at one year of liver transplantation. Male gender, pretransplant diabetes, hepatorenal syndrome, posttransplant hypertension, bilirubin >1.2 mg/dl, albumin <3.5 g/dl, pretransplant serum creatinine >1.4 mg/dl and tacrolimus trough level >7 µg/l at 3 rd month of liver transplantation were significant risk factors for the development of renal dysfunction. Reduction of tacrolimus dosage was the most effective intervention to restore renal function. This however resulted in abnormal liver function tests secondary to rejection and necessitated the addition of alternative non-nephrotoxic immunosuppressants. Two and four year survival rates were 98.9 and 96.6% for patients without renal dysfunction compared to 97.4 and 91.6% for those complicated by renal dysfunction after living donor liver transplant. Maintaining lower levels of tacrolimus along with addition of non-nephrotoxic immunosuppressants may be a worthwhile strategy to protect the kidneys and preserve long term graft function in patients at high risk of post living donor liver transplant renal dysfunction. Key words: Immunosuppressants, living donor liver transplantation, renal dysfunction, risk factorsLiver transplantation outcomes have improved greatly with advances in surgical techniques since the 1960s. With 1 year liver transplant (LT) survival rates now beyond 85% [1] , increased attention is being paid to improve long term morbidity and mortality in LT recipients. Renal dysfunction is the most worrisome long term complication following LT. It was estimated that 18% of the recipients would develop chronic renal failure within 5 years of LT which may in turn decrease patient survival [2][3][4] . Several factors have been implicated for the occurrence of chronic renal impairment in LT recipients [2,4,5] . Among these, high level exposure to calcineurin inhibitors, namely cyclosporine A and tacrolimus, is a well-documented risk factor [2,6,7] . Chronic calcineurin-induced nephrotoxicity is associated with structural changes in the kidney [8][9][10] .After India's first successful living donor liver transplant (LDLT) in the year 1998, nearly 7500 LTs have been performed across the country at the various LT centers which stand up to 30 as of 2015 [11] . Though a considerable number of research and review articles have been published [12][13][14][15][16][17][18][19] since then on the various aspects ...

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Section: Resultsmentioning

confidence: 98%