(Health Korea News / Changyong Lee) Research results have identified the optimal immunosuppressive therapy to reduce the risk of chronic kidney disease and renal failure in liver transplant patients.
Liver transplant patients use the immunosuppressant tacrolimus to suppress rejection that occurs when their immune system attacks the transplanted organ. Caution is required because the drug causes nephrotoxicity.
Soon-gyu Lee, Professor of Gastroenterology at Incheon St. Mary’s Hospital, Catholic University of Korea, and Jong-Young Choi, former Professor of Gastroenterology at Seoul St. Mary’s Hospital of Catholic University (currently Chung-Ang University Gwangmyeong Hospital), analyzed the impact of changes in dosage and concentration of tacrolimus on the occurrence of chronic kidney disease and renal failure, and analyzed the optimal concentration of tacrolimus and its excessive concentration. Research has begun to identify the risks of concentration changes.
The research team investigated the occurrence of chronic kidney disease and renal failure by tracking 952 patients who received liver transplants from 2000 to 2018 at Seoul St. Mary’s Hospital of the Catholic University of Korea.
The results of the study showed that patients suffering from acute kidney disease at the time of liver transplantation had a significantly increased incidence of chronic kidney disease and renal failure even after transplantation. It was found that in patients with normal renal function at the time of liver transplantation, the occurrence of chronic kidney disease can be reduced when the tacrolimus concentration is maintained below 4.5 ng/mL, and the risk of developing chronic kidney disease is highest when the concentration is above 6.9 ng/mL.
Patients who maintained normal renal function for up to 1 year after transplantation found that the incidence of chronic kidney disease could be reduced when the tacrolimus concentration was maintained below 4.0 ng/mL, and chronic patients with large changes in blood concentration of immunosuppressants were at risk of chronic kidney disease and renal failure. It was found that the risk of occurrence was significantly high.
The research team also confirmed that the use of ‘Tenofovir Disoproxil Fumarate (TDF)’ in patients with diabetes and hepatitis B is a significant factor in chronic kidney disease.
The research team said, “It is meaningful in that we identified the optimal concentration of tacrolimus to reduce chronic kidney disease in liver transplant patients and revealed the impact of changes in tacrolimus concentration on the occurrence of chronic kidney disease and renal failure, which had not been clearly identified so far.” “It was also an achievement to find that TDF, which is used for diabetes and hepatitis B patients, is a significant factor in chronic kidney disease even in liver transplant patients, confirming the need for management of diabetes and hepatitis B drugs,” he said.
Professor Soon-gyu Lee said, “Chronic kidney disease and renal failure in liver transplant patients are important diseases that affect the patient’s prognosis, and it is important to reduce their occurrence. Tacrolimus, an important immunosuppressant, is nephrotoxic, so what is the appropriate use? “More importantly, from this perspective, this is an important study that can help with the management of tacrolimus in liver transplant patients.”
Professor Choi Jong-young said, “This study revealed that delicate management of tacrolimus, an important immunosuppressant in liver transplant patients, is important in preventing renal function decline,” and added, “It could help improve the patient’s prognosis.” .
The results of this study were published in the latest issue of ‘Clinical and Molecular Hepatolog’, the journal of the Korean Association for the Study of the Liver.
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