PMID- 21796759
OWN - NLM
STAT- MEDLINE
DCOM- 20120221
LR  - 20140730
IS  - 1527-6473 (Electronic)
IS  - 1527-6465 (Linking)
VI  - 17 Suppl 3
DP  - 2011 Nov
TI  - Hot-topic debate on kidney function: renal-sparing approaches are beneficial.
PG  - S43-9
LID - 10.1002/lt.22392 [doi]
AB  - 1. Renal function is frequently compromised in candidates for transplantation 
      with advanced cirrhosis. These patients frequently have chronic and irreversible 
      kidney changes at the time of transplantation. 2. The accumulated incidence of 
      chronic renal failure is high in liver transplant recipients. Chronic renal 
      failure has a deleterious impact on the outcome. 3. Calcineurin inhibitor 
      (CNI)-based immunosuppression is highly effective at preventing rejection. 
      However, CNI nephrotoxicity has a central role in the occurrence of chronic renal 
      failure. 4. Renal function impairment frequently occurs within the first year 
      after transplantation. Once renal function is significantly impaired [glomerular 
      filtration rate (GFR) < 60 mL/minute/1.73 m(2) ], any intervention is unlikely to 
      result in a return to normal renal function. Early interventions are needed to 
      prevent chronic and irreversible kidney injury. 5. De novo CNI minimization has 
      been proven to be effective at reducing the rate of impaired renal function after 
      transplantation. The reduction in the CNI doses should be offset by the addition 
      of mycophenolate mofetil or enteric-coated mycophenolate sodium. 6. Delayed CNI 
      minimization in patients with established renal insufficiency may result in a 
      significant improvement in the GFR, even though the increase in the GFR after 
      minimization is generally modest. 7. Mammalian target of rapamycin (mTOR) 
      inhibitors are considered nonnephrotoxic immunosuppressive agents. They may be an 
      option for improving renal function in liver transplant recipients. However, not 
      all patients with renal dysfunction benefit from a switch to mTOR inhibitors. In 
      addition, the benefits in terms of renal function should be balanced against 
      specific side effects. 8. New immunosuppressive agents without intrinsic 
      nephrotoxicity are currently under development for solid organ transplantation. 
      These agents could help to reduce the burden of impaired renal function in 
      transplantation in the near future.
CI  - Copyright (c) 2011 American Association for the Study of Liver Diseases.
FAU - Durand, Francois
AU  - Durand F
AD  - Department of Hepatology and Liver Intensive Care, Beaujon Hospital, and 
      Bichat-Beaujon Center of Biomedical Research (National Institute of Health and 
      Medical Research Unit 773), University of Paris VII, Clichy, France. 
      francois.durand@bjn.aphp.fr
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Liver Transpl
JT  - Liver transplantation : official publication of the American Association for the 
      Study of Liver Diseases and the International Liver Transplantation Society
JID - 100909185
RN  - 0 (Immunosuppressive Agents)
SB  - IM
MH  - Graft Rejection/drug therapy
MH  - Humans
MH  - Immunosuppressive Agents/therapeutic use
MH  - Incidence
MH  - Kidney/*physiology
MH  - Kidney Failure, Chronic/*epidemiology/physiopathology/prevention & control
MH  - Liver Failure/*epidemiology/*surgery
MH  - Liver Transplantation/*methods
MH  - Postoperative Complications/*epidemiology/physiopathology/prevention & control
EDAT- 2011/07/29 06:00
MHDA- 2012/02/22 06:00
CRDT- 2011/07/29 06:00
PHST- 2011/07/29 06:00 [entrez]
PHST- 2011/07/29 06:00 [pubmed]
PHST- 2012/02/22 06:00 [medline]
AID - 10.1002/lt.22392 [doi]
PST - ppublish
SO  - Liver Transpl. 2011 Nov;17 Suppl 3:S43-9. doi: 10.1002/lt.22392.