A Case Report of Introducing with Mainly MMF and Steroid as an Immunosuppressive Therapy after Living-donor Liver Transplantation for a Patient with the Diabetic Nephropathy

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 ecompensated liver cirrhosis secondary to hepatitis B (Child-Pugh C, MELD score 11points) and chronic renal failure due to diabetic nephropathy (Cr 1.56mg/dl, GFR 27ml/min/1.73m^2) 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 540g, 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 (1500mg/day) and steroid (250mg/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 postoperativerenal function, the low-dose CNI, cyclosporin (50mg/day) was able to be added to the introduced immunosuppressive therapy. After having left the hospital, MMF (1500mg/day), steroid (20mg/day converted into predonisolone) and cyclosporin (75mg/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