The adverse pharmacology of calcineurin inhibitors and their impact on hepatitis C recurrence after liver transplantation

Implications for clinical practice

Mauricio Garcia-Saenz-De-Sicilia, Sandeep Mukherjee

Research output: Contribution to journalReview article

4 Citations (Scopus)

Abstract

Calcineurin inhibitors are widely used as maintenance immunosuppressants in solid-organ transplantation to minimize the risk of allograft rejection. Although the use of these agents has transformed the outcomes for patient and graft survival, this has come at a cost, notably the well-known adverse events of nephrotoxicity and metabolic abnormalities, to name a few. Over the last decade, tremendous interest has also focused on the impact of these medications on the replication of hepatitis C virus (HCV), with cyclosporine in particular having a negative effect on viral replication in vitro. Although small retrospective studies suggested that there may be a beneficial effect with cyclosporine on the progression of recurrent HCV and response to interferon, these findings have not been validated in several well-designed randomized controlled trial studies. The authors will review the pharmacology and pharmacokinetics of these well-known drugs and discuss the impact of these medications on the natural history of HCV recurrence after liver transplantation.

Original languageEnglish
Pages (from-to)587-593
Number of pages7
JournalExpert Review of Clinical Pharmacology
Volume5
Issue number5
DOIs
StatePublished - Sep 2012
Externally publishedYes

Fingerprint

Hepatitis C
Hepacivirus
Liver Transplantation
Pharmacology
Recurrence
Cyclosporine
Organ Transplantation
Graft Survival
Immunosuppressive Agents
Natural History
Interferons
Names
Allografts
Randomized Controlled Trials
Retrospective Studies
Pharmacokinetics
Maintenance
Costs and Cost Analysis
Pharmaceutical Preparations
Calcineurin Inhibitors

All Science Journal Classification (ASJC) codes

  • Pharmacology (medical)
  • Pharmacology, Toxicology and Pharmaceutics(all)

Cite this

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abstract = "Calcineurin inhibitors are widely used as maintenance immunosuppressants in solid-organ transplantation to minimize the risk of allograft rejection. Although the use of these agents has transformed the outcomes for patient and graft survival, this has come at a cost, notably the well-known adverse events of nephrotoxicity and metabolic abnormalities, to name a few. Over the last decade, tremendous interest has also focused on the impact of these medications on the replication of hepatitis C virus (HCV), with cyclosporine in particular having a negative effect on viral replication in vitro. Although small retrospective studies suggested that there may be a beneficial effect with cyclosporine on the progression of recurrent HCV and response to interferon, these findings have not been validated in several well-designed randomized controlled trial studies. The authors will review the pharmacology and pharmacokinetics of these well-known drugs and discuss the impact of these medications on the natural history of HCV recurrence after liver transplantation.",
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