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Use of mycophenolate mofetil in liver transplantation: Andalusian Liver Registry
L Barrera-Pulido1, D Marin, M de la Mata
1Hepatobiliary-Pancreatic Surgery and Liver Transplantation Unit, Virgen del Rocio University Hospital, Seville, Spain. lydiabarrera@hotmail.com
Objective:
To evaluate the safety and efficacy of various immunosuppressant regimens using mycophenolate mofetil (MMF).
Patients And Methods:
This prospective, observational, multicenter study of 226 patients undergoing liver transplantation was carried out in 2005-2006, with 24-month follow-up. Studied variables were as follows: indicators of kidney, liver, and blood function; intercurrent infections; cardiovascular risk; acute and chronic episodes of rejection; recurrent hepatitis C virus infection; de novo tumors; and survival. Patients were classified into 4 groups according to treatment: no MMF (group 1, n = 91); MMF from induction (group 2, n = 83); late administration of MMF (group 3, n = 30); and MMF at induction, with early withdrawal (group 4, n = 22).
Results:
Biodemographic characteristics were similar in all 4 groups. The MMF groups were at higher risk and had worse Model for End-Stage Liver Disease and Child-Pugh scores and worse pretransplantation blood and kidney function values. Significant differences were observed in creatinine concentration between groups 2 and 3: 0.45 mg/dL at 1 month (P < .01), 0.27 mg/dL at 3 months (P < .01), and 0.3 mg/dL at 6 months (P < .05). In contrast, differences of 0.34 mg/dL (P < .01) were observed between groups 1 and 3 at 1 month and 0.17 mg/dL (P < .05) between groups 1 and 2 at 3 months. No differences were noted in white blood cell counts, episodes of acute rejection (19%) and chronic rejection (5%), graft survival (80%), and rate of recurrent hepatitis C virus infection (75%) between the 4 groups. The infection rate at 3 months in groups 2 and 4 was 34.5%, and in groups 1 and 3 was 34.5% (P < .05).
Conclusions:
Use of MMF at induction and introduction of MMF in the first 3 months posttransplantation helps to preserve and restore creatinine levels in patients with worsened kidney function, and aids in keeping them stable, without increasing the risk of rejection while optimizing the anticalcineurin dosage.
Insights
Early use of mycophenolate mofetil (MMF) in liver transplant recipients improves kidney function without increasing rejection risk. This immunosuppressant regimen helps preserve renal function post-transplantation.
Area of Science:
- Transplantation immunology
- Nephrology
- Immunosuppression therapy
Background:
- Liver transplantation is a complex procedure requiring effective immunosuppression to prevent rejection.
- Mycophenolate mofetil (MMF) is a widely used immunosuppressant, but its optimal timing and impact on renal function require further investigation.
- Assessing MMF's role in preserving kidney function post-liver transplant is crucial for long-term patient outcomes.
Purpose of the Study:
- To evaluate the safety and efficacy of different immunosuppressant regimens involving mycophenolate mofetil (MMF) in liver transplant recipients.
- To determine the impact of MMF administration timing on renal function, rejection rates, and patient survival.
- To compare outcomes between patients receiving MMF at induction versus late administration or no MMF.
Main Methods:
- Prospective, observational, multicenter study of 226 liver transplant patients with 24-month follow-up.
- Patients were categorized into four groups based on MMF treatment: no MMF, MMF from induction, late MMF administration, and MMF with early withdrawal.
- Key variables included kidney and liver function, infections, cardiovascular risk, rejection episodes, hepatitis C recurrence, de novo tumors, and survival.
Main Results:
- MMF groups exhibited higher pretransplant risk scores but showed significant improvements in creatinine levels when MMF was administered early (at induction or within 3 months).
- No significant differences were observed in rejection rates (acute/chronic), graft survival, or hepatitis C recurrence across the four groups.
- Infection rates at 3 months were similar between early MMF groups and the no-MMF group, but higher than late MMF administration.
Conclusions:
- Initiating MMF at induction or within the first three months post-liver transplantation aids in preserving and restoring kidney function.
- Early MMF administration can stabilize renal function without increasing rejection risk and may allow for optimized calcineurin inhibitor dosage.
- This strategy is beneficial for liver transplant recipients with pre-existing or developing renal impairment.
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