Retrospective Study
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World J Gastroenterol. Aug 28, 2014; 20(32): 11356-11362
Published online Aug 28, 2014. doi: 10.3748/wjg.v20.i32.11356
Effect of low-dose tacrolimus with mycophenolate mofetil on renal function following liver transplantation
Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei
Jing-Cheng Hao, Wen-Tao Wang, Lu-Nan Yan, Bo Li, Tian-Fu Wen, Jia-Yin Yang, Ming-Qing Xu, Ji-Chun Zhao, Yong-Gang Wei, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Yan LN and Wang WT designed the research; Hao JC collected and analyzed the data; Li B, Wen TF, Yang JY, Xu MQ, Zhao JC and Wei YG performed data acquisition and provided technical support; and Hao JC wrote the paper.
Supported by Grants from The National Sciences and Technology Major Project of China, No. 2012ZX10002-016 and 2012ZX10002-017
Correspondence to: Lu-Nan Yan, MD, Department of Liver Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China. yanlvnan688@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: January 12, 2014
Revised: March 15, 2014
Accepted: April 21, 2014
Published online: August 28, 2014
Abstract

AIM: To determine whether low-dose tacrolimus (TAC) combined with mycophenolate mofetil (MMF) is a safe approach to decrease the incidence of chronic kidney disease (CKD) in liver transplantation (LT) recipients.

METHODS: We analyzed the medical records of 689 patients who underwent LT between March 1999 and December 2012 in a single Chinese center. Immunosuppression was initiated with a calcineurin inhibitor (TAC or CSA) and prednisone with or without MMF. CKD is defined by the glomerular filtration rate (GFR), estimated by an abbreviated Modification of Diet in Renal Disease formula, < 60 mL/min per 1.73 m2 for at least 3 consecutive months after LT. Individuals with TAC trough concentrations ≤ 8 ng/mL at 3 mo after LT were defined as the low-dose group. The incidence of CKD within 5 years was compared between the TAC group and the CSA group, as well as between four subgroups (low-dose and high-dose TAC groups with or without MMF).

RESULTS: No difference regarding the occurrence of pre-LT renal dysfunction or that of post-LT rejection was found between the TAC and CSA groups or between the four subgroups. With a definition of GFR < 60 mL/min per 1.73 m2, the overall incidence of CKD was significantly higher in the CSA group than in the TAC group. The incidence of CKD in the low-dose TAC + MMF group (7.7%) was significantly lower than that observed in the low-dose TAC group (15.9%), high-dose TAC group (24.6%) and high-dose TAC + MMF group (18.5%). The cumulative 1-, 3- and 5-year incidence rates of CKD were 12.7%, 14.5% and 16.7%, respectively. The cumulative 5-year survival rates were 61.7% and 82.2% in patients with or without CKD, respectively.

CONCLUSION: In LT patients, the choice of immunosuppressive therapy appears to affect renal function and patient survival.

Keywords: Liver transplantation, Chronic kidney disease, Calcineurin inhibitor, Mycophenolate mofetil

Core tip: Calcineurin inhibitor nephrotoxicity has been proposed to have a central role in chronic kidney disease, which has become a leading cause of long-term morbidity and mortality after liver transplantation. This study was conducted in 689 consecutive liver transplantation recipients and suggested that the choice of the immunosuppression therapy should be low-dose tacrolimus combined with mycophenolate mofetil, as this treatment was associated with better renal function and a higher patient survival rate.