الفهرس 
Liver transplantationOnly 14 pages are availabe for public view
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Abstract
Living donor liver transplantation (LDLT) is now an accepted treatment modality for end-stage liver disease. It has become alternative in the era of organ shortage.
As survival after liver transplantation has improved, there has been increasing concern regarding the long-term complications of post-transplant immunosuppression. Perhaps the most important of these is chronic renal impairment, which is now recognized to be a major cause of morbidity and mortality after liver transplantation.
The primary goals of liver transplantation are to prolong life and to improve the quality of life. Thus, it is essential to optimize patient selection and ideally time the transplant procedure so as to gain the maximum benefit. However, complications are common in the early and long term period and contribute to significant morbidity and mortality.
Like most other allografts, a liver transplant will be rejected by the recipient unless immunosuppressive drugs are used. The immunosuppressive regimens for all solid organ transplants are fairly similar, and a variety of agents are now available.
Knowledge of immunosuppressive medications and their side effects, as well as potential individual drug interactions, is important in the management of liver transplant patients. The complications associated with immunosuppressive medications accrue with longer exposure. Over half of the deaths in liver transplant patients are related to complications attributable to anti-rejection medications including cardiovascular disease, renal failure, infection or malignancy.
It has been widely reported that continued therapy with calcineurin inhibitors can cause an up to fourfold increase in morbidity and mortality in long-term liver transplant patients due to the development of chronic renal failure as well as neurotoxicity, arterial hypertension, hyperglycemia, hyperlipidemia, and increased risk of de novo tumors.
This study was conducted on 45 patients with end stage liver disease who underwent liver transplantation. According to their post-transplant immunosuppressive regimen, the patients were divided into 2 groups:
Group (1): who received the tacrolimus (Calcineurin inhibitors) as an immunosuppressive drug, they were thirty patients of the recipients (66.7%).
Group (2): who received cyclosporine-based immunosuppressive regimens and were fifteen patients of the recipients (33.3%).
The aim of the study was to identify the various post-transplant complications in liver transplant recipients receiving tacrolimus versus cyclosporine-based regimen and to identify the risk factors associated with chronic renal impairment (as the most common complication) in liver transplant recipients receiving tacrolimus versus cyclosporine-based regimen.
The study determined no significant statistical difference between both groups as regards all different parametric laboratory data (pre- and immediate post-transplantation).
There was significant statistical difference within each group as regards some parametric laboratory data including: [creatinine, Albumin, T. Bilirubin, D. Bilirubin, WBCs, AST and platelets (approaching significance), ALT and Triglyceride (highly significance)] while no significant statistical difference as regards the others, during pre- and immediate post-transplantation.
There was significant statistical difference between both groups as regards [AST and Cholesterol] and no significant statistical difference as regards the rest of the parametric laboratory data, during the first year post-transplantation).
Also, during the first year post-transplantation, there was significant statistical difference within each group as regards some laboratory data including: [creatinine, WBCs and Triglyceride, ALP and Cholesterol (highly significance)] while no significant statistical difference as regards the rest of laboratory data.
But there was no significant statistical difference between both groups or within each group as regards all parametric laboratory data, during the follow up post-transplantation.
There was significant statistical difference as regards the mean of serum level of tacrolimus and the target serum level, at development of renal complications.
Also, hepato-Cellular Carcinoma (HCC) showed statistical significant difference between groups with or without renal impairment in which the renal complications is the dependent factor (i.e: HCC is a risk factor for renal complications after liver transplantation).
Finally, the most common cause of complications after liver transplantation (especially Chronic Kidney Disease) is immunosuppressive drugs which are used after the operations to prevent rejection and prolong allograft survival, especially Calcineurin inhibitors (CNIs), so lowering the doses of CNIs or using other alternatives should be kept in mind and should be started as regards liver-transplant recipients in attempts to minimize post-liver transplant nephrotoxicity.