Hot-topic debate on kidney function: Renal-sparing approaches are beneficial

Durand, François

doi:10.1002/lt.22392

Cited by 8 publications

(9 citation statements)

References 36 publications

(56 reference statements)

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“…Because of the large number of determinants of HCC recurrence,15, 19 a 1‐year HCC recurrence rate of 0% to 11% and an overall recurrence rate at any time of 11% to 29% do not differ significantly from the results of reported series. Finally, in terms of renal function, which is one of the major endpoints in most CNI minimization studies,7 it is difficult to draw conclusions from this study because a clear definition of chronic kidney disease is lacking. Information about other potentially relevant endpoints that are usually evaluated in CNI minimization studies (eg, arterial hypertension and diabetes) is not reported.…”

Section: Hcv Recurrence In Hcv‐infected Lt Recipients Given Ratg or Amentioning

confidence: 98%

“…In 2008, almost 98% of LT recipients in the United States received CNIs at hospital discharge 3. With the increasing number of LT procedures and the longer follow‐up of survivors as well as the recent increase in the number of suboptimal candidates,4 a greater awareness of these limitations (particularly nephrotoxicity) has rapidly evolved 5‐7. Two major approaches have been assessed to minimize morbidity and mortality.…”

Section: Hcv Recurrence In Hcv‐infected Lt Recipients Given Ratg or Amentioning

confidence: 99%

“…The second strategy is the improvement of current immunosuppression protocols in order to minimize CNI exposure without compromising survival. The reduction of CNI doses (with or without delays) and the use of nonnephrotoxic agents [eg, mycophenolate mofetil (MMF), mammalian target of rapamycin inhibitors, and antibody induction] have been investigated6, 7, 10, 11 with acceptable (though not striking) results.…”

Section: Hcv Recurrence In Hcv‐infected Lt Recipients Given Ratg or Amentioning

confidence: 99%

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Rabbit anti-thymocyte globulin in liver transplantation: All that glitters is not gold, but 1000 patients are so many to dazzle

Berenguer

Pons

2012

Liver Transpl

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With increasing survival rates (73%-74% and 68%-69% on average at 5 years for patient and graft survival, respectively), liver transplantation (LT) has become the standard of care for patients with endstage liver disease. The development of effective immunosuppressive drugs and particularly calcineurin inhibitors (CNIs) has been essential to this success, 1,2 and despite known limitations, they continue to be the first-line therapy in organ transplantation. In 2008, almost 98% of LT recipients in the United States received CNIs at hospital discharge. 3With the increasing number of LT procedures and the longer follow-up of survivors as well as the recent increase in the number of suboptimal candidates, 4 a greater awareness of these limitations (particularly nephrotoxicity) has rapidly evolved.5-7 Two major approaches have been assessed to minimize morbidity and mortality. The first strategy, which has mostly been orchestrated by pharmaceutical companies, is the development of new agents that lack CNI-related side effects, such as belatacept and sotrastaurin.Although the drugs are good in that respect, they have not fulfilled expectations in terms of overall survival benefits. 8,9 Whether these agents will be potent enough to allow CNI avoidance is unclear. The second strategy is the improvement of current immunosuppression protocols in order to minimize CNI exposure without compromising survival. The reduction of CNI doses (with or without delays) and the use of nonnephrotoxic agents [eg, mycophenolate mofetil (MMF), mammalian target of rapamycin inhibitors, and antibody induction] have been investigated 6,7,10,11 with acceptable (though not striking) results.In this issue of Liver Transplantation, Mangus et al.12 present their experience with rabbit anti-thymocyte globulin (rATG)-based immunosuppression induction in 1013 LT recipients followed for a median of 63 months. The authors compare 3 immunosuppression eras in which rATG induction (3 doses for a total of 6 mg/kg) was used according to different protocols together with tacrolimus (TAC) monotherapy (started on postoperative day 2). In the first era (2001-2002, n ¼ 166), the first dose of rATG was administered perioperatively; in the second era (2003)(2004)(2005), n ¼ 259), the first rATG dose was delayed until 48 hours after transplantation; and in the third era

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Section: Hcv Recurrence In Hcv‐infected Lt Recipients Given Ratg or Amentioning

confidence: 98%

Section: Hcv Recurrence In Hcv‐infected Lt Recipients Given Ratg or Amentioning

confidence: 99%

Section: Hcv Recurrence In Hcv‐infected Lt Recipients Given Ratg or Amentioning

confidence: 99%

See 1 more Smart Citation

Rabbit anti-thymocyte globulin in liver transplantation: All that glitters is not gold, but 1000 patients are so many to dazzle

Berenguer

Pons

2012

Liver Transpl

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“…Calcineurin inhibitors (CNIs) have immediate, vasoconstriction‐mediated, and longterm nephrotoxicity in addition to severe metabolic side effects. Multiple large multicenter studies have investigated successful strategies to reduce CNI exposure after LT, including everolimus use and delaying CNI introduction . However, these findings may be difficult to extrapolate to LT recipients with pretransplant renal failure by virtue of their study design: the ReSpECT trial, for instance, studied the feasibility of delayed CNI introduction but excluded patients with SCr above 2.3 mg/dL on the day of transplant or who needed RRT …”

Section: Procedural Therapy and Renal Replacement Therapymentioning

confidence: 99%

“…Multiple large multicenter studies have investigated successful strategies to reduce CNI exposure after LT, including everolimus use and delaying CNI introduction. (54) However, these findings may be difficult to extrapolate to LT recipients with pretransplant renal failure by virtue of their study design: the ReSpECT trial, for instance, studied the feasibility of delayed CNI introduction but excluded patients with SCr above 2.3 mg/dL on the day of transplant or who needed RRT. (55) For patients with pretransplant renal dysfunction, data on immediate postoperative immunosuppressant management are scarce.…”

Section: Transplant-related 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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Post–Liver Transplant Acute Kidney Injury

Dong

Karvellas

2021

Liver Transpl.

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Acute kidney injury (AKI) is a common condition following liver transplantation (LT). It negatively impacts patient outcomes by increasingthe chances of developing chronic kidney disease and reducing graft and patient survival rates. Multiple definitions of AKI have been proposed and used throughout the years, with the International Club of Ascites definition being the most widely now used for patients with cirrhosis. Multiple factors are associated with the development of post-LT AKI and can be categorized into pre-LT comorbidities, donor and recipient characteristics, operative factors, and post-LT factors. Many of these factors can be optimized in an attempt to minimize the risk of AKI occurring and to improve renal function if AKI is already present. A special consideration during the post-LT phase is needed for immunosuppression as certain immunosuppressive medications can be nephrotoxic. The calcineurin inhibitor tacrolimus (TAC) is the mainstay of immunosuppression but can result in AKI. Several strategies including use of the monoclonoal antibody basilixamab to allow for delayed initiation of tacrolimus therapy and minimization through combination and minimization or elimination of TAC through combination with mycophenolate mofetil or mammalian target of rapamycin inhibitors have been implemented to reverse and avoid AKI in the post-LT setting. Renal replacement therapy may ultimately be required to support patients until recovery of AKI after LT. Overall, by improving renal function in post-LT patients with AKI, outcomes can be improved.

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Hot-topic debate on kidney function: Renal-sparing approaches are beneficial

Cited by 8 publications

References 36 publications

Rabbit anti-thymocyte globulin in liver transplantation: All that glitters is not gold, but 1000 patients are so many to dazzle

Rabbit anti-thymocyte globulin in liver transplantation: All that glitters is not gold, but 1000 patients are so many to dazzle

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

Post–Liver Transplant Acute Kidney Injury

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