Identification of immunosuppressive therapy to reduce the risk of chronic kidney disease and renal failure in liver transplant patients
Oct 27, 2024
The results of a study have been published to identify the optimal immunosuppressive therapy to reduce the risk of chronic kidney disease and renal failure in liver transplant patients.
Lee Soon-kyu, a professor of gastroenterology at Catholic University's Incheon St. Mary's Hospital, and Choi Jong-young, a former professor of gastroenterology at Catholic University's Seoul St. Mary's Hospital (currently Chung-Ang University Gwangmyeong Hospital), recently published a paper titled 「"The identification of optimal immunosuppressive therapy to reduce the risk of chronic kidney disease and renal failure in liver transplantation" in the famous journal 『Clinical and Molecular Hepatology』".
In liver transplant patients, tacrolimus, an important immunosuppressant used to suppress rejection caused by the immune system attacking transplanted organs, is nephrotoxic and requires attention. Therefore, Professor Lee Soon-kyu's research team tried to analyze the effects of tacrolimus on chronic kidney disease and renal failure by analyzing changes in dose and concentration, and to identify the optimal concentration of tacrolimus and the risk of excessive concentration changes.
The research team investigated the occurrence of chronic kidney disease and renal failure through follow-up observation of 952 patients who underwent liver transplantation from 2000 to 2018 at Catholic University of Korea's Seoul St. Mary's Hospital.
As a result of the study, first, it was confirmed that patients with acute renal disease at the time of liver transplantation significantly increased the incidence of chronic renal disease and renal failure even after transplantation. In addition, in patients with normal renal function at the time of liver transplantation, chronic kidney disease can be reduced when the concentration of tacrolimus is maintained below 4.5 ng/mL, and the risk of chronic kidney disease is highest when it is above 6.9 ng/mL.
In addition, it was found that patients who maintained normal renal function until a year after transplantation can reduce the incidence of chronic kidney disease when the concentration of tacrolimus is maintained below 4.0 ng/mL, and that chronic patients with large changes in blood concentrations of immunosuppressants have a significantly higher risk of developing chronic kidney disease and renal failure.
The research team also confirmed that the use of 'tenofovir disoproxil fumarate (TDF)' is a significant factor in chronic kidney disease in patients with diabetes and hepatitis B.
Regarding this study, the research team explained that it is meaningful to identify the optimal concentration of tacrolimus to reduce chronic kidney disease in liver transplant patients, and to reveal the effect of changes in tacrolimus concentration, which has not been clearly identified so far, on the occurrence of chronic kidney disease and renal failure.
In addition, it was also analyzed as an achievement that TDF use in liver transplant patients is a significant factor in chronic kidney disease, confirming that diabetes and hepatitis B drugs need to be managed.
Professor Lee Soon-gyu evaluated "Chronic kidney disease and renal failure in liver transplant patients are important diseases affecting the prognosis of patients, and it is important to reduce their occurrence" and "Since tacrolimus, an important immunosuppressant, is nephrotoxic, its proper use is of paramount importance, and from this point of view, this study is an important study that can help manage tacrolimus in liver transplant patients."
Professor Choi Jong-young expected that `This study has revealed that delicate management of tacrolimus, an important immunosuppressant for liver transplant patients, is important in preventing renal function decline, and it will help improve the prognosis of patients in the future.'
Lee Soon-kyu, a professor of gastroenterology at Catholic University's Incheon St. Mary's Hospital, and Choi Jong-young, a former professor of gastroenterology at Catholic University's Seoul St. Mary's Hospital (currently Chung-Ang University Gwangmyeong Hospital), recently published a paper titled 「"The identification of optimal immunosuppressive therapy to reduce the risk of chronic kidney disease and renal failure in liver transplantation" in the famous journal 『Clinical and Molecular Hepatology』".
In liver transplant patients, tacrolimus, an important immunosuppressant used to suppress rejection caused by the immune system attacking transplanted organs, is nephrotoxic and requires attention. Therefore, Professor Lee Soon-kyu's research team tried to analyze the effects of tacrolimus on chronic kidney disease and renal failure by analyzing changes in dose and concentration, and to identify the optimal concentration of tacrolimus and the risk of excessive concentration changes.
The research team investigated the occurrence of chronic kidney disease and renal failure through follow-up observation of 952 patients who underwent liver transplantation from 2000 to 2018 at Catholic University of Korea's Seoul St. Mary's Hospital.
As a result of the study, first, it was confirmed that patients with acute renal disease at the time of liver transplantation significantly increased the incidence of chronic renal disease and renal failure even after transplantation. In addition, in patients with normal renal function at the time of liver transplantation, chronic kidney disease can be reduced when the concentration of tacrolimus is maintained below 4.5 ng/mL, and the risk of chronic kidney disease is highest when it is above 6.9 ng/mL.
In addition, it was found that patients who maintained normal renal function until a year after transplantation can reduce the incidence of chronic kidney disease when the concentration of tacrolimus is maintained below 4.0 ng/mL, and that chronic patients with large changes in blood concentrations of immunosuppressants have a significantly higher risk of developing chronic kidney disease and renal failure.
The research team also confirmed that the use of 'tenofovir disoproxil fumarate (TDF)' is a significant factor in chronic kidney disease in patients with diabetes and hepatitis B.
Regarding this study, the research team explained that it is meaningful to identify the optimal concentration of tacrolimus to reduce chronic kidney disease in liver transplant patients, and to reveal the effect of changes in tacrolimus concentration, which has not been clearly identified so far, on the occurrence of chronic kidney disease and renal failure.
In addition, it was also analyzed as an achievement that TDF use in liver transplant patients is a significant factor in chronic kidney disease, confirming that diabetes and hepatitis B drugs need to be managed.
Professor Lee Soon-gyu evaluated "Chronic kidney disease and renal failure in liver transplant patients are important diseases affecting the prognosis of patients, and it is important to reduce their occurrence" and "Since tacrolimus, an important immunosuppressant, is nephrotoxic, its proper use is of paramount importance, and from this point of view, this study is an important study that can help manage tacrolimus in liver transplant patients."
Professor Choi Jong-young expected that `This study has revealed that delicate management of tacrolimus, an important immunosuppressant for liver transplant patients, is important in preventing renal function decline, and it will help improve the prognosis of patients in the future.'
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