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Should kidneys pay the price ▸

Calcineurin inhibitor (cyclosporin or tacrolimus) therapy has significantly improved survival among patients who have received organ transplantation. However, these drugs which form a key component of immunosuppressive regimens have been implicated in the development of chronic renal failure. Ojo et al used a population based cohort of 69 321 subjects in the Scientific Registry of Transplant Recipients (SRTR) to determine the incidence of chronic renal failure in those receiving non-renal (heart, lung, liver, and intestine) transplantation. During a median follow up of 36 months, 16.5% developed chronic renal failure (defined as a glomerular filtration rate of ⩽29 ml/min per 1.73 m2 of body surface area). The cumulative incidence of chronic renal failure at five years was highest in those with intestinal transplantation (21%) followed by liver transplantation (18%), and the risk increased with increasing age, female sex, hepatitis C, hypertension, diabetes, and postoperative acute renal failure. In those undergoing liver transplantation, the risk was higher with cyclosporin than that with tacrolimus. The occurrence of chronic renal failure was associated with more than a fourfold risk …

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