Efficacy of minimal dosage of calcineurin inhibitor for living donor liver transplant recipients with preoperative renal dysfunction

Background/Aims: There is no standard protocol for immunosuppression for patients with preoperative chronic renal dysfunction (PCRD) scheduled for living donor liver transplantation (LDLT). In this prospective study, we evaluated the efficacy of low-dose calcineurin inhibitor (CNI) protocol for such patients. Methodology: We studied 17 consecutive LDLT recipients with PCRD (creatinine clearance <50mL/min). Six patients (LD-B group) received combination of low-dose CNI (LD-CNI), mycophenolate mofetil, corticosteroids, and anti-CD25 monoclonal antibody (mAb). Their clinical data were compared with conventional CNI group (N group, n=8) and LD-CNI without CD25 mAb group (LD group, n=3). Results: Preoperative characteristics and incidence of acute rejection were similar in the three groups. None of the LD-B group recipients developed renal failure, while one (9%) did in the N group. Patient survival was better in the LD-B group than control groups. Conclusion: Our renal sparing protocol is feasible and effective for LDLT recipients with PCRD.