الفهرس 
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Abstract
RD mainly due to CNIs nephrotoxicity, is the most common complication following LT. Renal insufficiency, whether acute or chronic after LT represents a major cause of morbidity and mortality following LT.This retrospective study included 110 recipients who underwent LT. 87 recipients underwent LDLT in NLI, Menoufia University during the period from April 2003 until the end of the study in September 2011. Another 23 recipients underwent DDLT in China and were followed in the LT clinic in NLI.ARD was defined as post-LT serum Cr > 1.5 mg/dl among patients with normal pre-LT renal functions. CRD was defined as ARD for more than 6 months, or ESRF on maintenance hemodialysis or RRT.The main indications for LT included HCV related liver cirrhosis in 60 (54.5%) recipients, while HCC was diagnosed in 27 (24.5%) recipients, congenital causes in 12 (10.9%) recipients, Budd-chiari in 2 cases, HBV in one case, HBV with HCC in one case, HBV with HCV in one case, HCV with HBV with HCC in one case, alpha-1-antitrypsin in one case, alcoholic liver disease in one case, Wilson disease in one case and finally cryptogenic liver cirrhosis in 2 cases. With no significant effect of etiology of ESLD in the incidence of post-LT RD either ARD or CRD.Eighty seven recipients (79%) underwent LDLT and 23 (21%) underwent DDLT outside the country. FK immunosuppressant wasconclusion administered to 89 (81.0%) recipients and CsA was administered to 21 (19%) recipients as primary immunosuppressive.Post-LT ARD was diagnosed in 23 (20.9%) recipients, and 9 (8.1%) recipients progressed to CRD, with no statistically significant difference in the incidence of nephrotoxicity among recipients received FK or CsA as primary immunosuppressive.Due to CNIs induced nephrotoxicity, 23 recipients required dose modification, either dose reduction or discontinuation. The dose reduction significantly improved the renal function.The patients survival with post-LT nephrotoxicity was 67% in 5 years which was slightly lower than the other recipients without post-LT nephrotoxicity (71% in 5 years survival), but without statistically significant difference.In conclusion; early diagnosis and management of renal dysfunction after LT is very important. CNIs induced nephrotoxicity is usually reversible and could be treated by dose reduction or replacement with anther immunosuppressant drugs( as sirolimus or MMF).