title: Mycophenolate mofetil can be used as monotherapy late after liver transplantation.
abstract: We report our experience with calcineurin inhibitor (CNI) withdrawal and MMF monotherapy in 50 adult liver transplant (OLT) recipients with CNI-related toxicity. Thirty-four patients had chronic renal dysfunction (CRD) associated with arterial hypertension, 11 had only CRD and other five patients had hypertension. The mean time between OLT and introduction of MMF was 81 months. After the introduction of MMF, CNI was progressively reduced and withdrawn if possible. At the end of the follow up (mean time: 18 months) CNI was withdrawn in 39 patients (78%), and there was a significant decrease from baseline in serum creatinine (1.81-1.49 mg/dL; p < 0.0001), BUN (76.6-52.8 mg/dL; p < 0.0001) and uric acid (9-7.5 mg/dL; p < 0.0001) levels, and an increase in creatinine clearance (44.7-55.1 mL/min; p < 0.0001). Excluding patients who developed graft rejection and two patients who died, CRD improved in 32 of 40 patients (80%), and arterial hypertension improved in 22 of 29 patients (76%). Five patients (10%) developed acute rejection, and one patient (2%) chronic rejection. Twenty-six patients (52%) experienced side-effects, with asthenia, herpes virus infection, and diarrhea being the most common. Only eight patients (16%) required MMF dose reduction. In conclusion, MMF monotherapy late after OLT improves CRD and hypertension in most patients, is safe and well tolerated.
authors.affiliation: Liver Transplantation Unit, University Hospital Peurta De Hierro, Madrid, Spain. josemariamoren@mixmail.com
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Moreno Planas
authors.forename: Valentin
authors.initials: V
authors.lastname: Cuervas-Mons Martinez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rubio Gonzalez
authors.forename: Amparo
authors.initials: A
authors.lastname: Gomez Cruz
authors.forename: Javier
authors.initials: J
authors.lastname: Lopez-Monclus
authors.forename: Victor
authors.initials: V
authors.lastname: Sánchez-Turrion
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lucena Poza
authors.forename: Manuel
authors.initials: M
authors.lastname: Jimenez Garrido
authors.forename: Isabel
authors.initials: I
authors.lastname: Millan
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid