Brief Article
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World J Gastroenterol. Mar 7, 2012; 18(9): 991-998
Published online Mar 7, 2012. doi: 10.3748/wjg.v18.i9.991
Prophylaxis of chronic kidney disease after liver transplantation - experience from west China
Zhen-Yong Shao, Lu-Nan Yan, Wen-Tao Wang, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei
Zhen-Yong Shao, Lu-Nan Yan, Wen-Tao Wang, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Liver Transplantation Center, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Shao ZY and Yan LN provided the conception and designed the study; Shao ZY made the data analysis and drafted the article; Yan LN and Wang WT revised the manuscript and obtained funding; Li B, Wen TF, Yang JY, Xu MQ, Zhao JC and Wei YG provided data acquisition and technical support, also involved in editing the manuscript.
Supported by Chinese Key Project for Prophylaxis and Treatment of Infection Diseases, No. 2008ZX10002-025 and No. 2008ZX10002-026
Correspondence to: Lu-Nan Yan, MD, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. yanlunanhxyh@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: May 15, 2011
Revised: September 22, 2011
Accepted: September 29, 2011
Published online: March 7, 2012
Abstract

AIM: To evaluate the prophylaxis of chronic kidney disease (CKD) after liver transplantation (LT) with low-dose calcineurin inhibitor (CNI) and mycophenolate mofetil (MMF).

METHODS: From March 1999 to December 2009, a total of 572 patients (478 males and 94 females) underwent LT enrolled in the study. Initial immunosuppression was by triple-drug regimens that included a CNI, MMF, and prednisone. The initial dose of CNI was 0.05-0.10 mg/kg per day for tacrolimus (TAC) and 5-10 mg/kg per d for cyclosporine A (CSA) respectively, and was gradually reduced based on a stable graft function. The serum trough level of CNI was 6-8 ng/mL for TAC and 120-150 ng/mL for CSA 3-mo post-operation, 4-6 ng/mL for TAC and 80-120 ng/mL for CSA 1-year after transplantation was expected with stable liver function. MMF was personalized between 1.0-1.5 g/d. Glomerular filtration rate (GFR) was estimated by an abbreviated Modification of Diet in Renal Disease formula. Risk factors of CKD were examined by univariate and multivariate logistic regression.

RESULTS: With a definition of GFR < 60 mL/min per 1.73 m2, the incidence of CKD was 17.3% 5-year after LT. There were 68.3% (293 of 429 cases) patients managed to control their TAC trough concentrations within 8 ng/mL and 58.0% (83 of 143 cases) patients’ CSA trough concentrations within 150 ng/mL. Of the 450 recipients followed-up over 1 year, 55.5% (183 of 330 cases) of which were treated with TAC had a trough concentration ≤ 6 ng/mL while 65.8% (79 of 120 cases) of which were treated with CSA had a concentration ≤ 120 ng/mL. The incidence of CKD in the groups of lower CNI trough concentrations was significantly lower than the groups with CNI concentrations above the ideal range. Patients with CKD had much higher CNI trough concentrations than that of patients without CKD. MMF was adopted in 359 patients (62.8%). Patients administrated with MMF had a relatively low CNI trough concentrations but with no significant difference. The graft function remained stable during follow-up. No difference was found between different groups of CNI trough concentrations. Pre-LT renal dysfunction, ages, acute kidney injury, high blood trough concentrations of CNI in 3 mo (TAC > 8 ng/mL, CSA > 150 ng/mL) and hypertension after operation were associated with CKD progression, while male gender and adoption of MMF were protection factors.

CONCLUSION: Low dose of CNI combined with MMF managed to prevent CKD after LT with stable graft function.

Keywords: Liver transplantation; Chronic kidney disease; Calcineurin inhibitor; Mycophenolate mofetil; Risk factor