Rethinking chronic kidney disease risk after liver transplantation

Table 3 Efficacy of calcineurin inhibitor minimization strategies on renal outcomes post-liver transplantation

Ref.	Strategy	Primary mechanism of renal protection	Renal outcome	Trade-off/safety signal	Evidence source
Muñoz-Serrano et al[1], 2025; Kong et al[17], 2011	MMF addition/conversion	Reduces the required CNI trough level	Significant long-term eGFR improvement	Low rejection rate; generally well tolerated	Retrospective study Meta-analysis/conversion studies
Lange et al[15], 2018; Hashim et al[16], 2020	Basiliximab induction	Enables delayed CNI initiation	Reduces medium-term renal dysfunction post-LT (7.1% incidence)	Does not adversely affect BPAR or survival	Clinical trial/review
Saliba et al[19], 2022	EVR avoidance	Non-nephrotoxic primary mechanism	Renal function potentially better preserved in actual treatment subgroups	Higher BPAR; higher rate of de novo cancer observed	Observational/follow-up study

BPAR: Biopsy-proven acute rejection; LT: Liver transplantation; CNI: Calcineurin inhibitor; eGFR: Estimated glomerular filtration rate; EVR: Everolimus; MMF: Mycophenolate mofetil.