Calcineurin inhibitors in liver transplantation – still champions or threatened by serious competitors?
Article first published online: 27 FEB 2013
© 2013 John Wiley & Sons A/S
Volume 33, Issue 5, pages 656–665, May 2013
How to Cite
Liver Int. 2013: 33: 656–665
- Issue published online: 7 APR 2013
- Article first published online: 27 FEB 2013
- Accepted manuscript online: 5 FEB 2013 07:29AM EST
- Manuscript Accepted: 29 JAN 2013
- Manuscript Received: 29 DEC 2012
- calcineurin inhibitor-sparing regimens;
- liver transplantation;
- renal dysfunction
Current strategies for immunosuppression in liver transplant (LT) recipients include the design of protocols targeting a more individualized approach to reduce risk factors such as renal failure, cardiovascular complications and malignancies. Renal injury in LT recipients may be often multifactorial and is associated with increased risk of post-transplant morbidity and mortality. The quest for low toxicity immunosuppressive regimens has been challenging and resulted in CNI minimization protocols or CNI withdrawal and conversion to mycophenolate mofetil (MMF) and/or mammalian target of rapamycin inhibitor-based immunosuppressive regimens. Use of antibody induction to delay CNI administration may be an option in particular in immunocompromized, critically ill patients with high MELD scores. Protocols including MMF introduction and concomitant CNI minimization have the potential to recover renal function even in the medium and long term after LT. We review on hot topics in the prevention and management of acute and chronic renal injury in LT patients. For this purpose, we present and critically discuss results from immunosuppressive studies published in the current literature or presented at recent LT meetings.