title: Long-term outcome of adding mycophenolate mofetil to tacrolimus for nephrotoxicity following liver transplantation.
abstract: Mycophenolate mofetil (MMF) has no known nephrotoxicity. This report examines the outcome in patients who received MMF for renal impairment on tacrolimus-based immunosuppression. From 1995 to 1996, twelve liver transplantation (LTx) patients (mean age 54.6 years) with serum creatinine >1.8 mg/dl were included in the study. MMF was introduced and tacrolimus dose was reduced by 30-50%. Each patient was followed for 6 years. Renal function showed improvement in seven patients, deterioration in four, and no change in one patient. Overall mean serum creatinine decreased from 2.5 to 1.9 mg/dl at 6 months but increased to 2.2 mg/dl at 18 to 24 months. After that, renal function remained stable for 72 months. Iothalamate clearance showed 18.5% improvement at 1 year. Three patients developed renal failure. Six patients died in the follow-up period. Addition of MMF with reduced tacrolimus dose resulted in sustained improvement in renal function in 58% of patients.
authors.affiliation: Department of Surgery, Transplant Division, Strong Memorial Hospital, University of Rochester, Rochester, NY 14642, USA. ashok_jain@urmc.rochester.edu
authors.forename: Ashokkumar
authors.initials: A
authors.lastname: Jain
authors.forename: Raman
authors.initials: R
authors.lastname: Vekatramanan
authors.forename: Bijan
authors.initials: B
authors.lastname: Eghtesad
authors.forename: Mary
authors.initials: M
authors.lastname: Gadomski
authors.forename: Ravi
authors.initials: R
authors.lastname: Mohanka
authors.forename: Amadeo
authors.initials: A
authors.lastname: Marcos
authors.forename: John
authors.initials: J
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging; D003401:Creatine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000494:pharmacology; D007677:Kidney Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D009929:Organ Size; D051437:Renal Insufficiency / Q000097:blood / Q000139:chemically induced* / Q000473:pathology; D012727:Sex Characteristics; D015996:Survival Rate; D016559:Tacrolimus / Q000009:adverse effects* / Q000494:pharmacology; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D003401:Creatine; D016559:Tacrolimus