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The renal benefit of mycophenolate mofetil after liver transplantation
Samuel Haywood1, Michael Abecassis, Josh Levitsky
1Division of Hepatology, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA.
Background:
The risk and benefit of adding mycophenolate mofetil (MMF) to a standard immunosuppressive regimen at the time of liver transplantation (LT) is not well described.
Methods:
We performed a retrospective case-control analysis comparing one-yr outcomes of all LT recipients at our institution treated with post-operative tacrolimus (TAC), MMF, and steroids vs. TAC and steroids.
Results:
A total of 101 LT recipients (50:51 case:control) were analyzed. Despite more renal dysfunction at LT, the MMF + TAC group had similar serum creatinine (Cr) and glomerular filtration rate (GFR) as the TAC group one-yr post-LT. In this time period, Cr decreased (1.57-1.22 mg/dL, p = 0.04) and GFR increased (57.5-65.1 mL/min per 1.73 m(2), p = 0.05) in the MMF + TAC group, while Cr increased (1.11-1.35, p < 0.01) and GFR declined (73.5-60.1, p < 0.001) in the TAC group. These findings occurred without a difference in absolute rejection episodes, hospitalizations, infections, deaths, or time to above events (p > 0.05). Subgroup analysis of patients stratified by pre-transplant renal dysfunction (Cr ≥ 1.2 mg/dL) supported the previous. MMF was reasonably well tolerated with a low rate of discontinuation.
Conclusions:
The use of adjunctive MMF immediately after LT may protect against calcineurin inhibitor nephrotoxicity, potentially without the need for dose reduction or increased risk of adverse events.
Insights
Adding mycophenolate mofetil (MMF) to a standard liver transplant (LT) regimen may protect kidney function without increasing adverse events. This study found MMF improved renal outcomes compared to tacrolimus alone one year post-LT.
Area of Science:
- Nephrology
- Immunosuppression
- Transplantation
Background:
- The benefits and risks of adding mycophenolate mofetil (MMF) to standard immunosuppression post-liver transplantation (LT) are not well-established.
- Calcineurin inhibitor (CNI)-induced nephrotoxicity is a significant concern in LT recipients.
Purpose of the Study:
- To evaluate the impact of adding MMF to a tacrolimus (TAC) and steroid regimen on one-year outcomes in liver transplant recipients.
- To assess the effect of MMF on renal function and compare it to a standard TAC and steroid regimen.
Main Methods:
- Retrospective case-control analysis of 101 liver transplant recipients.
- Comparison of outcomes between patients treated with TAC, MMF, and steroids versus TAC and steroids post-operatively.
Main Results:
- The MMF + TAC group showed improved renal function (decreased creatinine, increased GFR) at one year compared to the TAC-only group, despite higher baseline renal dysfunction.
- No significant differences were observed in rejection episodes, hospitalizations, infections, or mortality between the groups.
- MMF was well-tolerated with a low discontinuation rate.
Conclusions:
- Adjunctive MMF use immediately after LT may mitigate CNI-induced nephrotoxicity.
- MMF can potentially be used without requiring CNI dose reduction or increasing the risk of adverse events.
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