Renal function after liver transplantation

Transplantation Proceedings, 1997

Transplantation

Background. Liver transplant recipients are at risk of chronic renal disease, principally as a result of nephrotoxicity of the commonly used immunosuppressive agents cyclosporine and tacrolimus. We have investigated the incidence of chronic renal failure and its risk factors in our transplant population, which was treated predominantly with cyclosporine.

Clinical Transplantation, 2008

Chronic renal dysfunction (CRD) after transplantation of a non-renal organ has been widely recognized as a major complication that significantly compromises patientsÕ outcome (1-3). Since a number of patients undergoing liver transplantation already present with varying degrees of renal dysfunction, including hepatorenal syndrome (HRS), prior to liver transplantation, and standard immunosuppression protocols are based on calcineurin inhibitors (CI) with known nephrotoxic side effects, a majority of liver recipients develop some degree of renal insufficiency. These side effects remain one of the most significant factors on mortality and morbidity in liver transplantation and are related to many post-operative decisions . A single-center study has demonstrated that within 13 yr following liver transplantation, 18.1% of patients developed severe renal dysfunction. Over half of these ultimately presented with end-stage renal disease requiring hemodialysis (6). These results were confirmed by a large multicenter study that found chronic renal failure in 16.5% of 69,321 patients with non-renal transplantation including liver, heart, lung, and intestine (7). Although CI, like cyclosporine or tacrolimus, were the major reason for the dramatic improvement of survival in transplantation medicine, these drugs were not only associated with a number of post-operative complications like neurotoxicity, hyperlipidemia, hypertension, and diabetes , Schmitz V, Laudi S, Moeckel F, Puhl G, Stockmann M, Tran ZV, Kahl A, Neumann U, Neuhaus P. Chronic renal dysfunction following liver transplantation. Clin Transplant 2008: 22: 333-340. ª 2008 Blackwell Munksgaard

Liver Transplantation, 2002

With the increasing success of liver transplantation, more patients are developing late complications such as renal dysfunction. The goal of the current study was to assess the prevalence of renal dysfunction years &er liver transplantation and to identify patients at risk for the development of this complication. Of the 527 liver transplantations performed at our institution between April 1990 and October 1998,353 had pretransplantation and posttransplantation glomerular filtration rate (GFR) determinations by iothalamate clearance. From this entire group, 198 patients had actual 4-year follow-up and 52 had actual 6-year follow-up. In addition, 19 1 of these patients had intensive follow-up with GFR measurements pretransplantation and at 1 and 3 years posttransplantation (complete follow-up group). AU patients received either tacrolimus-or cyclosporine-based immunosuppression. The overall mean GFR levels in both of these groups was acceptable and was not different in cyclosporine-versus tacrolimus-based immunosuppressive regimens. Renal dysfunction was progressive, with 27.5% of patients in the intensive group having a GFR C 40 mL/min/body surface area 5 years after transplantation. GFR pretransplantation did not correlate well with late renal function; however, GFR at 1 year identified patients with subsequent renal dysfunction. The cumulative incidence of renal failure for the entire group was 6.25% at 7 years and 10% at 10 years.

Pediatric Transplantation, 2012

Transplantation, 1998

Background. Liver transplant recipients are at risk of chronic renal disease, principally as a result of nephrotoxicity of the commonly used immunosuppressive agents cyclosporine and tacrolimus. We have investigated the incidence of chronic renal failure and its risk factors in our transplant population, which was treated predominantly with cyclosporine.

Advances in Therapy, 2004

The immunosuppressive agents cyclosporine A and tacrolimus have demonstrated efficacy in preventing acute organ rejection after renal transplantation, but no comparative studies of these 2 agents have been published. This study compared the effects of tacrolimus and cyclosporine A on the renal function, blood pressure, and serum glucose and lipid levels of patients who underwent cyclosporine A therapy and C 2 monitoring or tacrolimus therapy and standard monitoring during the first 24 months after transplantation. By the end of the follow-up period, no significant difference between either treatment group was noted in the measures of creatine clearance; BUN, glucose, uric acid, and lipid levels; or diastolic blood pressure (P>.05 for all), which were maintained at normal values throughout the study. Systolic blood pressure was significantly lower in the cyclosporine A group at the end of the 1st month (P<.025) but this difference was not evident at months 6, 12, and 24 (P>.05). These results indicate that tacrolimus and cyclosporine (when combined with C 2 monitoring) were equally effective and safe in preventing acute organ rejection.

Liver Transplantation, 2009

The prevalence of renal insufficiency before and at 1, 12, and 60 months after liver transplantation (LTx; primary endpoint) and the changes in the glomerular filtration rate (GFR) at same time points according to the immunosuppressive regimen (coprimary endpoint) were investigated. The primary outcome was determined for the entire cohort, whereas the coprimary endpoint was determined only for 2 groups of patients: those who started and remained on a calcineurin inhibitor (CNI) alone, that is, the CNI-alone group (n ϭ 624), and those who started and remained on a CNI in combination with mycophenolate mofetil (MMF), that is, the MMF group (n ϭ 117). GFR was Ͻ60 mL/minute/1.73 kg/m 2 in 11%, 48%, 51% and 58% of the patients at baseline and at 1, 12, and 60 months, respectively. The decrease in GFR was significantly lower in the MMF group compared to the CNI-alone group at 12 and 60 months (Ϫ16% versus Ϫ30% and Ϫ15% versus Ϫ33%, respectively), whereas the GFR decrease at 1 month was not different between the 2 groups. There were no significant differences between the 2 groups in CNI doses or blood levels at 12 and 60 months. In conclusion, there was a worsening of renal failure in 83% of patients post-LTx; 58% and 5% had GFRs of Ͻ60 and Ͻ30 mL/minute/1.73 kg/m 2 , respectively, at 5 years after LTx. The reduction of the GFR was significantly less marked in the MMF group compared to the CNI-alone agroup, and this could be related to less important CNI exposure early after LTx. It seems likely that early intervention for CNI reduction is best for reducing the use of CNIs in the long term.

2004

Go to AGRIS search. Revisiting garden-based learning in basic education. ...

Nurnadila, Junedi Suprianto, 2022

Penelitian ini bertujuan untuk mengetahui implementasi pemberdayaan aparatur dalam menerapkan prinsip-prinsip Good Governance di Sekretariat Daerah Provinsi Kalimantan Utara. Tipe penelitian yang digunakan adalah penelitian kuantitatif dengan