Long-Term Effects of Calcineurin Inhibitors on Renal Function After Liver Transplantation

The longer survival of liver transplant recipients has emphasized the need to consider complications that develop several years after liver transplantation, such as chronic renal dysfunction. Renal dysfunction has an impact on long-term posttransplant morbidity and mortality. The prevalence of chronic renal disease among liver transplant recipients varies widely from 10 to 78%. This renal dysfunction is multifactorial in origin, but is customarily considered to be secondary to calcineurin inhibitors, tacrolimus and cyclosporine, acute dose-dependent and chronic non dose-dependent nephrotoxicity. With the occurrence of powerful immunosuppressive drugs without renal side-effects (i.e. mycophenolate mofetil and sirolimus), there have been several reports on the management of calcineurin inhibitorinduced nephrotoxicity, with either reduction or complete withdrawal of calcineurin inhibitors. Most of them resulted in an improvement in renal function. The point is to assess if reduction is sufficient to reverse renal lesions. Concerning prevention of renal function deterioration, the best way is on the one hand to try to control the potential contributors to chronic renal failure, such as hypertension, hyperlipidemia, and diabetes mellitus, and on the other hand to decrease the cumulative doses of calcineurin inhibitors. In an attempt to prevent renal dysfunction after liver transplantation, several investigators have published studies designed to reduce the dose and/or to delay the introduction of calcineurin inhibitors, with the use of mycophenolate mofetil and/or anti-CD25 antibodies induction. (Trends in Transplant. 2008;2:129-34) Corresponding author: Georges-Philippe Pageaux, [email protected]