title: MMF and calcineurin taper in recurrent hepatitis C after liver transplantation: impact on histological course.
abstract: 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.
authors.affiliation: Medizinischa Klinik mit Schwerpunht, Hepatologie, Gastroentorologie, Universitätsklinikum Charité and Campus Virchow-Klinikum, Humboldt-Universität, Berlin, Germany. marcus.bahra@charite.de
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: U I F P
authors.initials: UI
authors.lastname: Neumann
authors.forename: Dietmar
authors.initials: D
authors.lastname: Jacob
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
authors.forename: Jochen
authors.initials: J
authors.lastname: Klupp
authors.forename: Jan M
authors.initials: JM
authors.lastname: Langrehr
authors.forename: Thomas
authors.initials: T
authors.lastname: Berg
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: 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
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D012367:RNA, Viral; D009173:Mycophenolic Acid; D016559:Tacrolimus