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Use of mycophenolate mofetil as rescue therapy after pediatric liver transplantation
C Chardot1, J E Nicoluzzi, M Janssen
1Cliniques Universitaire Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
Background:
Mycophenolate mofetil (MMF) has been increasingly used after liver transplantation (LT) in adults. We report our preliminary experience with MMF as rescue therapy after pediatric LT.
Methods:
A total of 19 children received MMF for 21 indications. Median age at LT was 30 months (range 7-149). The median initial oral dose of MMF was 23 mg/kg/day (range 12-43) orally. Median follow-up after initiation of MMF therapy was 642 days (range 229-1606).
Results:
1) EFFICACY: MMF was indicated for rejection or insufficient immunosuppression in 16 cases, with normalization of both liver function tests and liver histology in 10 (62%). MMF was successfully used in one patient with post-LT immmune hepatitis and one patient with corticodependence. In three patients with renal function impairment, MMF allowed reduction of cyclosporine A or tacrolimus blood levels, without subsequent rejection. 2) Tolerance: Six patients (32%) experienced eight side effects, mainly gastrointestinal and hematological, which resolved after cessation of MMF in five cases and dose reduction in three. One case of posttransplant lymphoproliferative disease (PTLD) occurred under MMF therapy (5.2%). Four patients had EBV primary infection, while under MMF therapy, without subsequent PTLD. Three patients had CMV primary infection, and five CMV reactivation, under MMF therapy. Seven remained asymptomatic, and one presented with CMV enteritis.
Conclusions:
These preliminary results suggest that MMF is an effective and safe immunosuppressant in pediatric LT recipients. Its use is hampered by frequent gastrointestinal and hematological side-effects. MMF does not seem to increase the risk of PTLD nor CMV disease.
Insights
Mycophenolate mofetil (MMF) is effective and safe for pediatric liver transplant (LT) recipients. While side effects like gastrointestinal issues occur, MMF does not increase risks of PTLD or CMV disease.
Area of Science:
- Pediatric transplantation
- Immunosuppression
- Gastroenterology
Background:
- Mycophenolate mofetil (MMF) use is increasing in adult liver transplantation (LT).
- Limited data exists on MMF as rescue therapy in pediatric LT.
Purpose of the Study:
- To evaluate the efficacy and safety of MMF as rescue immunosuppression in pediatric LT recipients.
Main Methods:
- Retrospective analysis of 19 children receiving MMF for 21 indications post-LT.
- Median follow-up of 642 days.
- Dose: 23 mg/kg/day (range 12-43 mg/kg/day).
Main Results:
- MMF normalized liver function and histology in 62% of cases for rejection/insufficient immunosuppression.
- Successfully treated immune hepatitis and corticodependence.
- Allowed reduction of calcineurin inhibitors in renal impairment without rejection.
- Side effects (32%) were mainly gastrointestinal and hematological.
- One case of PTLD (5.2%) observed.
- No increased risk of PTLD with EBV infection; CMV infections occurred but were mostly manageable.
Conclusions:
- MMF is a potentially effective and safe immunosuppressant for pediatric LT.
- Gastrointestinal and hematological side effects are common but manageable.
- MMF does not appear to elevate the risk of PTLD or CMV disease in this cohort.