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.