Farkas, Stefan A. and Schnitzbauer, Andreas A. and Kirchner, Gabi and Obed, Aiman and Banas, Bernhard and Schlitt, Hans J. (2009) Calcineurin inhibitor minimization protocols in liver transplantation. TRANSPLANT INTERNATIONAL, 22 (1). pp. 49-60. ISSN 0934-0874, 1432-2277
Full text not available from this repository. (Request a copy)Abstract
Liver transplant recipients are at increasingly high risk for suffering from impaired renal function and probable need of renal replacement therapy. Extended criteria organs and transplantation of patients with higher model for end-stage liver disease scores further increase this problem. Acute and chronic nephrotoxicity are the trade-off in immunosuppression with potent calcineurin inhibitors (CNIs). As a good renal function is associated with better graft and patient survival, CNI minimization protocols have been developed. Current strategies to overcome CNI toxicity include reduction or withdrawal of CNIs concurrently with switching over to mammalian target of rapamycin inhibitor or mycophenolate mofetil (MMF)-based regimens. This strategy caused an improvement in renal function in a significant number of liver transplantation patients according to several studies. However, total CNI avoidance seems to result in higher rejection rates. To prevent chronic renal dysfunction in patients prone to or with acute renal failure, CNI delay - with induction therapy for bridging - followed by low-dose CNI in combination with MMF are proven strategies without risking higher rejection rates. An individualized, tailor-made immunosuppressive regime, with a special focus on renal function is recommended. This review gave an overview on CNI minimization protocols in liver transplantation also focusing on recently analyzed studies.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | ACUTE-RENAL-FAILURE; SIROLIMUS-BASED IMMUNOSUPPRESSION; ANTI-THYMOCYTE GLOBULIN; MYCOPHENOLATE-MOFETIL; CYCLOSPORINE NEPHROTOXICITY; INDUCTION THERAPY; RISK-FACTORS; ALEMTUZUMAB CAMPATH-1H; KIDNEY-TRANSPLANTATION; SERUM CREATININE; calcineurin inhibitors; cyclosporin; kidney function; liver transplantation; sirolimus; tacrolimus |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie Medicine > Lehrstuhl für Innere Medizin I Medicine > Abteilung für Nephrologie |
| Depositing User: | Petra Gürster |
| Date Deposited: | 22 Sep 2022 06:47 |
| Last Modified: | 22 Sep 2022 06:47 |
| URI: | https://pred.uni-regensburg.de/id/eprint/29894 |
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