MMF and calcineurin taper in recurrent hepatitis C after liver transplantation: impact on histological course.
Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is almost universal. The optimal immunosuppression for these patients is still under discussion. We designed a retrospective case-control study to evaluate the effect of mycophenolate mofetil (MMF) treatment in patients with recurrent hepatitis C. Forty patients with histologically proven hepatitis C recurrence after OLT were treated with MMF and calcineurin inhibitor (CNI) taper for 24 months and matched with 40 non-MMF-treated positive liver transplant recipients. Liver biopsies were obtained prior to MMF treatment and after a mean follow-up of 24 months. Histological changes were evaluated utilizing the Metavir score. Comparison of fibrosis/inflammation showed no impairment of histological findings during MMF treatment. In contrast, histological findings of the 40 non-MMF patients showed a significant increase of severity for inflammation/fibrosis. Viral load was similar in both groups. The course of alanin amino transferase (ALT) levels measured during MMF treatment showed a significant decrease. MMF in combination with CNI taper showed a positive effect on fibrosis progression, graft inflammation and ALT levels and may improve the clinical course of HCV after OLT, however, the antiviral properties of MMF are still unconfirmed.
Bahra
Marcus
M
Medizinischa Klinik mit Schwerpunht, Hepatologie, Gastroentorologie, Universitätsklinikum Charité and Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany. marcus.bahra@charite.de
Neumann
U I F P
UI
Jacob
Dietmar
D
Puhl
Gero
G
Klupp
Jochen
J
Langrehr
Jan M
JM
Berg
Thomas
T
Neuhaus
Peter
P
D065095:Calcineurin Inhibitors; D016022:Case-Control Studies; D005260:Female; D006084:Graft Rejection / Q000188:drug therapy; D016174:Hepacivirus / Q000235:genetics; D006526:Hepatitis C / Q000188:drug therapy*; D006801:Humans; D007166:Immunosuppressive Agents / Q000494:pharmacology*; D016031:Liver Transplantation; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology*; D012367:RNA, Viral / Q000378:metabolism; D012189:Retrospective Studies; D016559:Tacrolimus / Q000494:pharmacology; D013997:Time Factors
D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D009173:Mycophenolic Acid; D016559:Tacrolimus