Studying Calcineurin Inhibitors Metabolic Complications in Egyptian Liver Transplant Patients-A Single Center Trial

Abstract

Background: Calcineurin inhibitors (CNIs) (Tacrolimus and cyclosporine [CSA]) are immunosuppressive
drugs that are administrated to prevent liver rejection after liver transplantation. Their use has led to a reduced
prevalence of acute rejection and improved transplant survival. However, their use is associated with many
complications, these complications include hyperkalemia nephrotoxicity, hypertension (HTN), and new-onset
diabetes mellitus (NODM). This study aimed to detect the incidence of CNIs complications in Egyptian patients
after liver transplantation. Study Design: A retrospective evaluation with descriptive analysis study. Patients:
All adults admitted for liver transplantation from 2008 to 2016 were included in this study. Setting: The study
was conducted in the Liver Transplantation Unit, Ain Shams specialized hospital, Cairo, Egypt. Results: A total
of 196 patients’ medical files were retrospectively reviewed to detect the incidence of CNIs complications.
The tacrolimus group included 86 patients and the cyclosporin group included 92 patients. The prevalence of
developing HTN was lower in the cyclosporin group as only 25% of patients developed HTN versus 40% in the
tacrolimus group. The prevalence of NODM in the tacrolimus group was higher in the CSA group (33% vs. 16%).
The prevalence of hyperkalemia was 52% and 28% in group tacrolimus and cyclosporin groups, respectively. The
rate of nephrotoxicity in the tacrolimus group was 60% versus 48% in the cyclosporin group. Conclusions: These
findings may help guide physicians in their choice of immunosuppression and underscore the need for long-term
follow-up for blood sugar and potassium levels, blood pressure, and kidney function tests.