Mycophenolate mofetil monotherapy in liver transplantation

Area of Science:

• Nephrology
• Hepatology
• Immunosuppression

Background:

• Calcineurin inhibitors (CI) are associated with significant morbidity in transplant recipients.
• Liver transplantation (LT) requires effective immunosuppression to prevent rejection.
• Renal dysfunction is a common complication of CI therapy post-LT.

Purpose of the Study:

• To evaluate the effectiveness and safety of mycophenolate mofetil (MMF) monotherapy in liver transplant recipients.
• To assess the impact of MMF monotherapy on renal function.
• To determine the incidence of complications associated with MMF monotherapy.

Main Methods:

• Analysis of 32 liver transplant recipients (1994-2003).
• Patients were converted from cyclosporine or tacrolimus to MMF monotherapy.
• Efficacy assessed by serum creatinine levels; safety by incidence of rejection, leukopenia, and diarrhea.

Main Results:

• A statistically significant decrease in serum creatinine levels (2.02 to 1.7 mg/dL; P = .0001) was observed.
• MMF monotherapy was indicated primarily due to adverse effects of CI, particularly renal dysfunction (30 patients).
• Reported side effects included leukopenia (15.6%) and diarrhea (12.5%), with only one case of acute rejection.

Conclusions:

• MMF monotherapy significantly improved renal function in liver transplant recipients.
• This immunosuppressive regimen was not associated with a significant risk of allograft rejection.
• Mild side effects were observed with MMF dosages up to 750 mg twice daily.