Nephrotoxicity of cyclosporine in liver transplantation.

Abstract

Since the introduction of cyclosporine (CsA)-steroid therapy for our liver transplant recipients in March 1980, the survival rates have increased significantly as shown in Fig 1. The effective and relatively safe immunosuppression provided by CsA is undoubtedly the most important factor in the improved success rate.1 Fig 1 Actuarial survival after liver transplantation. Nephrotoxicity is a troublesome side effect of CsA. The distinction between nephrotoxicity and rejection poses a major diagnostic dilemma in renal transplantation,2 but not after extrarenal organ transplantation. However, end-stage liver diseases often predispose to renal dysfunction, and extensive surgical intervention also can cause acute renal impairment. Thus, a different kind of “artifact” may exist in the assessment of drug nephrotoxicity. Even so, liver transplantation provides a reasonable model to study some aspects of the nephrotoxicity of CsA. In this report, acute and chronic renal dysfunction among our liver transplant recipients will be described.