Calcineurin Inhibitor Free De Novo Immunosuppression in Liver Transplant Recipients With Pretransplant Renal Impairment

Schnitzbauer, Andreas A.; Sothmann, Johannes; Baier, L.; Bein, Thomas; Geissler, Edward K.; Scherer, Marcus N.; Schlitt, Hans J.

doi:10.1097/tp.0000000000000779

Cited by 22 publications

(9 citation statements)

References 15 publications

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“…A representative study reports the experience with a CNI‐free regimen of mycophenolate mofetil, steroids and basiliximab induction with delayed introduction of sirolimus in 27 adult patients with a median preoperative GFR of 24 mL/minute. Over the 1‐year follow‐up, these patients experienced no rejection and marked GFR improvements 113 …”

Section: Nephroprotective Strategies In Ltx Pediatric Patientsmentioning

confidence: 95%

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Lacquaniti

Campo

Tocco

et al. 2020

Clinical Transplantation

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Acute and chronic kidney injuries represent critical issues after liver transplantation (LTx), but whereas renal dysfunction in adult transplant patients is well documented, little is known about its prevalence in childhood. It is a challenge to accurately evaluate renal function in patients with liver disease, due to several confounding factors. Creatinine-based equations estimating glomerular filtration rate, validated in nephropathic patients without hepatic issues, are frequently inaccurate in end-stage liver disease, underestimating the real impact of renal disease. Moreover, whereas renal issues observed within 1 year from LTx were often related to acute injuries, kidney damage observed after 5-7 years from LTx, is due to chronic, irreversible mechanisms. Most immunosuppression protocols are based on calcineurin inhibitors (CNIs) and corticosteroids, but mycophenolate mofetil or sirolimus could play significant roles, also in children. Early diagnosis and personalized treatment represent the bases of kidney disease management, in order to minimize its close relation with increased mortality. This review analyzed acute and chronic kidney damage after pediatric LTx, also discussing the impact of pre-existent renal disease. The main immunosuppressant strategies have been reviewed, highlighting their impact on kidney function. Different methods assessing renal function were reported, with the potential application of new renal biomarkers.

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Section: Nephroprotective Strategies In Ltx Pediatric Patientsmentioning

confidence: 95%

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Lacquaniti

Campo

Tocco

et al. 2020

Clinical Transplantation

View full text Add to dashboard Cite

show abstract

“…A representative study reports the experience with a CNI-free regimen of mycophenolate mofetil, steroids, and basiliximab induction with delayed introduction of sirolimus in 27 patients with a median preoperative GFR of 24 mL/minute. (56) Over the 1-year follow-up, these patients experienced no rejection and marked GFR improvements, though there was no comparator group. Despite the scarcity of evidence, there is a trend in 2000-2009 toward increased use of CNI-free regimens, paralleling an increase in the prevalence of pretransplant renal dysfunction.…”

Section: Transplant-related Therapymentioning

confidence: 99%

“…For patients with pretransplant renal dysfunction, data on immediate postoperative immunosuppressant management are scarce. A representative study reports the experience with a CNI‐free regimen of mycophenolate mofetil, steroids, and basiliximab induction with delayed introduction of sirolimus in 27 patients with a median preoperative GFR of 24 mL/minute . Over the 1‐year follow‐up, these patients experienced no rejection and marked GFR improvements, though there was no comparator group.…”

Section: Procedural Therapy and Renal Replacement Therapymentioning

confidence: 99%

Management of renal failure in end‐stage liver disease: A critical appraisal

2016

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Renal failure is a late consequence of end-stage liver disease (ESLD). Even with liver transplantation, pretransplant renal impairment remains a strong predictor of posttransplant mortality. This review seeks to summarize and critically appraise common therapies used in this setting, including pharmacologic agents, procedures (transjugular intrahepatic portosystemic shunt, renal replacement therapy), and simultaneous liver-kidney transplantation. More experimental extracorporal modalities, eg, albumin dialysis or bioartificial livers, will not be discussed. A brief discussion on the definition and pathophysiologic underpinnings of renal failure in ESLD will be held at the beginning to lay the groundwork for the main section. Liver Transplantation 22 1710-1719 2016 AASLD.

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“…Während sich CNI-freie Regimes in der Frühphase nach LTx aufgrund hoher Abstoßungsraten nicht bewährt haben [26], werden sie im Langzeitverlauf gerade bei Patienten mit zunehmender CNI-induzierter Niereninsuffizienz eingesetzt [27].…”

Section: De-novo-therapieunclassified

Update: Immunsuppression bei Organtransplantationen

Kniepeiss¹,

Rosenkranz²,

Fickert³

et al. 2020

Allgemein- und Viszeralchirurgie up2date

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Calcineurin Inhibitor Free De Novo Immunosuppression in Liver Transplant Recipients With Pretransplant Renal Impairment

Abstract: Initial de novo CNI-free immunosuppressive bottom-up treatment is safe in selected patient groups. The critical period for relevant recovery of renal function seems to be the early period (first 30 days), independent from presence of sirolimus.

Cited by 22 publications

References 15 publications

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Acute and chronic kidney disease after pediatric liver transplantation: An underestimated problem

Management of renal failure in end‐stage liver disease: A critical appraisal

Update: Immunsuppression bei Organtransplantationen

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