[Case report of introducing MMF and steroids as an immunosuppressive therapy after living-donor liver transplantation for a patient with the diabetic nephropathy].

Shotaro Kuramitsu, Tomohiro Iguchi, Mizuki Ninomiya, Yo ichi Yamashita, Norifumi Harimoto, Toru Ikegami, Hideaki Uchiyama, Tomoharu Yoshizumi, Yuji Soejima, Ken Shirabe, Hirofumi Kawanaka, Tetsuo Ikeda, Toshiya Furuta, Ryuichiro Tamada, Yoshihiko Maehara

Research output: Contribution to journalArticle

Abstract

Calcineurin inhibitor (CNI) combined with mycophenolate mofetil (MMF) and steroid is mainly used as immunosuppressive therapy after the living-donor liver transplantation (LDLT). However, the nephrotoxicity caused by CNI remains a critical problem for patients with chronic renal failure, especially on early postoperative period. A 62-year-old woman with decompensated liver cirrhosis secondary to hepatitis B (Child-Pugh C, MELD score 11 points) and chronic renal failure due to diabetic nephropathy (Cr 1.56 mg/dl, GFR 27 ml/min/1.73 m2) experienced LDLT. During the reconstruction of hepatic vein, the supra-and infra-hepatic vena cava was totally clamped. The estimated right lobe liver graft volume was 540 g, representing 51.3% of the standard liver volume of the recipient. Because of the perioperative renal dysfunction due to diabetic nephropathy and the total clamping the vena cava which induced the congestion kidney, MMF (1500 mg/day) and steroid (250 mg/day converted into predonisolone) were mainly introduced as an immunosuppressive therapy after LDLT. The low-dose CNI, tacrolimus also induced the nephrotoxicity and was given for only a short time. Finally, according to the postoperative renal function, the low-dose CNI, cyclosporin (50 mg/day) was able to be added to the introduced immunosuppressive therapy. After having left the hospital, MMF (1500 mg/day), steroid (20 mg/day converted into predonisolone) and cyclosporin (75 mg/day) continued to be given as the immunosuppressive therapy and neither acute graft rejection nor drug-induced renal dysfunction was occurred. This is a case report of introducing with mainly MMF and steroid as an immunosuppressive therapy after LDLT for a patient with perioperative renal dysfunction.

Original languageEnglish
Pages (from-to)79-83
Number of pages5
JournalFukuoka igaku zasshi = Hukuoka acta medica
Volume105
Issue number3
Publication statusPublished - Jan 1 2014

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Mycophenolic Acid
Living Donors
Diabetic Nephropathies
Immunosuppressive Agents
Liver Transplantation
Steroids
Kidney
Venae Cavae
Cyclosporine
Chronic Kidney Failure
Liver
Therapeutics
Hepatic Veins
Graft Rejection
Tacrolimus
Hepatitis B
Postoperative Period
Constriction
Liver Cirrhosis
Transplants

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

[Case report of introducing MMF and steroids as an immunosuppressive therapy after living-donor liver transplantation for a patient with the diabetic nephropathy]. / Kuramitsu, Shotaro; Iguchi, Tomohiro; Ninomiya, Mizuki; Yamashita, Yo ichi; Harimoto, Norifumi; Ikegami, Toru; Uchiyama, Hideaki; Yoshizumi, Tomoharu; Soejima, Yuji; Shirabe, Ken; Kawanaka, Hirofumi; Ikeda, Tetsuo; Furuta, Toshiya; Tamada, Ryuichiro; Maehara, Yoshihiko.

In: Fukuoka igaku zasshi = Hukuoka acta medica, Vol. 105, No. 3, 01.01.2014, p. 79-83.

Research output: Contribution to journalArticle

Kuramitsu, S, Iguchi, T, Ninomiya, M, Yamashita, YI, Harimoto, N, Ikegami, T, Uchiyama, H, Yoshizumi, T, Soejima, Y, Shirabe, K, Kawanaka, H, Ikeda, T, Furuta, T, Tamada, R & Maehara, Y 2014, '[Case report of introducing MMF and steroids as an immunosuppressive therapy after living-donor liver transplantation for a patient with the diabetic nephropathy].', Fukuoka igaku zasshi = Hukuoka acta medica, vol. 105, no. 3, pp. 79-83.
Kuramitsu, Shotaro ; Iguchi, Tomohiro ; Ninomiya, Mizuki ; Yamashita, Yo ichi ; Harimoto, Norifumi ; Ikegami, Toru ; Uchiyama, Hideaki ; Yoshizumi, Tomoharu ; Soejima, Yuji ; Shirabe, Ken ; Kawanaka, Hirofumi ; Ikeda, Tetsuo ; Furuta, Toshiya ; Tamada, Ryuichiro ; Maehara, Yoshihiko. / [Case report of introducing MMF and steroids as an immunosuppressive therapy after living-donor liver transplantation for a patient with the diabetic nephropathy]. In: Fukuoka igaku zasshi = Hukuoka acta medica. 2014 ; Vol. 105, No. 3. pp. 79-83.
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abstract = "Calcineurin inhibitor (CNI) combined with mycophenolate mofetil (MMF) and steroid is mainly used as immunosuppressive therapy after the living-donor liver transplantation (LDLT). However, the nephrotoxicity caused by CNI remains a critical problem for patients with chronic renal failure, especially on early postoperative period. A 62-year-old woman with decompensated liver cirrhosis secondary to hepatitis B (Child-Pugh C, MELD score 11 points) and chronic renal failure due to diabetic nephropathy (Cr 1.56 mg/dl, GFR 27 ml/min/1.73 m2) experienced LDLT. During the reconstruction of hepatic vein, the supra-and infra-hepatic vena cava was totally clamped. The estimated right lobe liver graft volume was 540 g, representing 51.3{\%} of the standard liver volume of the recipient. Because of the perioperative renal dysfunction due to diabetic nephropathy and the total clamping the vena cava which induced the congestion kidney, MMF (1500 mg/day) and steroid (250 mg/day converted into predonisolone) were mainly introduced as an immunosuppressive therapy after LDLT. The low-dose CNI, tacrolimus also induced the nephrotoxicity and was given for only a short time. Finally, according to the postoperative renal function, the low-dose CNI, cyclosporin (50 mg/day) was able to be added to the introduced immunosuppressive therapy. After having left the hospital, MMF (1500 mg/day), steroid (20 mg/day converted into predonisolone) and cyclosporin (75 mg/day) continued to be given as the immunosuppressive therapy and neither acute graft rejection nor drug-induced renal dysfunction was occurred. This is a case report of introducing with mainly MMF and steroid as an immunosuppressive therapy after LDLT for a patient with perioperative renal dysfunction.",
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AU - Kuramitsu, Shotaro

AU - Iguchi, Tomohiro

AU - Ninomiya, Mizuki

AU - Yamashita, Yo ichi

AU - Harimoto, Norifumi

AU - Ikegami, Toru

AU - Uchiyama, Hideaki

AU - Yoshizumi, Tomoharu

AU - Soejima, Yuji

AU - Shirabe, Ken

AU - Kawanaka, Hirofumi

AU - Ikeda, Tetsuo

AU - Furuta, Toshiya

AU - Tamada, Ryuichiro

AU - Maehara, Yoshihiko

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Calcineurin inhibitor (CNI) combined with mycophenolate mofetil (MMF) and steroid is mainly used as immunosuppressive therapy after the living-donor liver transplantation (LDLT). However, the nephrotoxicity caused by CNI remains a critical problem for patients with chronic renal failure, especially on early postoperative period. A 62-year-old woman with decompensated liver cirrhosis secondary to hepatitis B (Child-Pugh C, MELD score 11 points) and chronic renal failure due to diabetic nephropathy (Cr 1.56 mg/dl, GFR 27 ml/min/1.73 m2) experienced LDLT. During the reconstruction of hepatic vein, the supra-and infra-hepatic vena cava was totally clamped. The estimated right lobe liver graft volume was 540 g, representing 51.3% of the standard liver volume of the recipient. Because of the perioperative renal dysfunction due to diabetic nephropathy and the total clamping the vena cava which induced the congestion kidney, MMF (1500 mg/day) and steroid (250 mg/day converted into predonisolone) were mainly introduced as an immunosuppressive therapy after LDLT. The low-dose CNI, tacrolimus also induced the nephrotoxicity and was given for only a short time. Finally, according to the postoperative renal function, the low-dose CNI, cyclosporin (50 mg/day) was able to be added to the introduced immunosuppressive therapy. After having left the hospital, MMF (1500 mg/day), steroid (20 mg/day converted into predonisolone) and cyclosporin (75 mg/day) continued to be given as the immunosuppressive therapy and neither acute graft rejection nor drug-induced renal dysfunction was occurred. This is a case report of introducing with mainly MMF and steroid as an immunosuppressive therapy after LDLT for a patient with perioperative renal dysfunction.

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