Renal failure late after liver transplantation

Abstract

In summary, therefore, long-term renal failure associated with the use of CNIs is a major problem in a small but significant number of long-term liver allograft recipients. Clinicians need to be aware of the risks and remember that serum creatinine levels are a relatively poor guide to renal function. Levels reflect not only renal function, but also nutrition and muscle mass; levels increase some time after the onset of progressive renal impairment. However, attention to renal function and careful monitoring of drug levels, especially in the first year, are important. Evidence of progressive renal impairment should alert the clinician, and alternative regimes should be considered. There are insufficient data at present to point to the best strategy, although there are several trials in progress. It is important, however, to place this problem in context and not move too swiftly to alternative immunosuppressive regimes, which could just substitute one major side-effect for another.