Related Experiment Video
Updated: Jun 20, 2026
Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
Published on: December 8, 2014
Switching from mycophenolate mofetil to enteric-coated mycophenolate sodium in liver transplant patients with
L Barrera-Pulido1, J M Alamo-Martínez, L M Marín-Gómez
1Hepatobiliopancreatic Surgery and Liver Transplant Unit, Virgen del Rocío University Hospital, Seville, Spain. lydiabarrera@hotmail.com
Objective:
Our aim was to safely and effectively reduce adverse gastrointestinal (GI) events resulting from the use of mycophenolate mofetil (MMF) in liver transplant patients by switching to enteric-coated mycophenolate sodium (EC-MPS).
Patients And Methods:
We studied 19 patients on maintenance therapy presenting with GI intolerance to MMF whose therapy was switched to EC-MPS. The variables recorded were: calcineurin inhibitor (CNI) dose levels, MMF/EC-MPS dose levels, lipid profile, hematology, renal and hepatic function markers, and rejection episodes. These variables were recorded at the visit prior to the day of conversion, on the day of conversion, and 1, 3, 6, and 9 months thereafter.
Results:
Of the 19 patients, 16 were men (mean age, 56.6 +/- 15.9 years) and 3 were women (58.3 +/- 12.1 years). While 31.6% were on MMF monotherapy, 52.6% were on combined therapy with tacrolimus and 15.8% with cyclosporine. On the day of conversion, 21% were not on MMF, 36.8% were on 1000 mg/d, 26.3% were on 1500 mg/d, 5.3% were on 750 mg/d, and 10.6% were on 500 mg/d. The starting daily doses of EC-MPS were: 360 mg (26.3%), 720 mg (31.6%), 540 mg (26.3%), 1080 mg (10.5%), and 1440 mg (5.3%). GI complications were significantly reduced from the first month postconversion (P < .01), as 57.2% of patients did not display any symptoms; however, at 9 months, this incidence rose by 12% relative to month 1 (P < .05). There were no changes in the other variables and there were no reported rejection episodes. Treatment was suspended in 2 patients due to dyspnea and nervousness.
Conclusion:
In liver transplant patients with GI complications from chronic MMF use, the use of EC-MPS was safe and efficacious, as it significantly reduced their incidence.
Insights
Switching liver transplant patients from mycophenolate mofetil (MMF) to enteric-coated mycophenolate sodium (EC-MPS) significantly reduced gastrointestinal (GI) complications. This therapeutic change proved safe and effective for managing MMF-related GI intolerance.
Area of Science:
- Transplantation Medicine
- Gastroenterology
- Pharmacology
Background:
- Mycophenolate mofetil (MMF) is a common immunosuppressant post-liver transplant.
- Gastrointestinal (GI) intolerance is a frequent adverse effect of MMF therapy.
- Managing GI complications is crucial for long-term transplant success.
Purpose of the Study:
- To evaluate the safety and efficacy of switching liver transplant patients from MMF to enteric-coated mycophenolate sodium (EC-MPS).
- To assess the reduction in GI adverse events associated with EC-MPS conversion.
- To monitor key clinical and laboratory variables following the switch.
Main Methods:
- A cohort of 19 liver transplant patients with MMF-induced GI intolerance was switched to EC-MPS.
- Clinical data, including calcineurin inhibitor (CNI) doses, MMF/EC-MPS doses, and GI symptom incidence, were collected.
- Laboratory parameters (lipid profile, hematology, renal/hepatic function) and rejection episodes were monitored for 9 months post-conversion.
Main Results:
- GI complications significantly decreased from the first month after switching to EC-MPS (P < .01).
- At 9 months, 57.2% of patients experienced no GI symptoms, though a slight increase was noted compared to month 1 (P < .05).
- No significant changes were observed in CNI doses, laboratory markers, or rejection episodes; treatment was suspended in 2 patients for unrelated reasons.
Conclusions:
- Switching to EC-MPS is a safe and effective strategy for liver transplant patients experiencing GI complications from MMF.
- EC-MPS demonstrates significant efficacy in reducing the incidence of MMF-related GI adverse events.
- This conversion maintains immunosuppression and biochemical stability without compromising transplant outcomes.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
01:24Drugs for Peptic Ulcer Disease: Sucralfate as Mucosal Protective Agents
In this scenario, mucosal protective agents like sucralfate play an essential role. Sucralfate, a complex of sulfated sucrose and aluminum hydroxide, demonstrates its usefulness in acidic conditions,...
01:27Pharmacogenetics of Phase II Enzymes: N-acetyltransferase, Thiopurine S-methyltransferase, UDP-glucuronosyltransferase
01:16Kidney Transplant III: Nursing Management
01:28Kidney Transplant I: Introduction
01:17Hepatic Drug Excretion: Enterohepatic Cycling
Post-release drugs and metabolites can be reabsorbed into the body from the intestine. For conjugated metabolites like glucuronides, reabsorption requires enzymatic hydrolysis by intestinal microflora. This...