Intravenous mycophenolate mofetil with low-dose oral tacrolimus and steroid induction for live donor liver transplantation.
OBJECTIVE
Mycophenolate mofetil (MMF) is used in liver transplantation (LTx) to reduce rejection, nephrotoxicity, neurotoxicity, and the need for steroids. Lower trough concentrations and bioavailability have been reported with oral MMF in first week after LTx. These parameters improve after the first month postoperatively. Previously published studies have used oral formulations of MMF. In this study, we sought to examine survival, rejection, and nephrotoxicity rates using IV MMF in live donor liver transplantation (LDLT).


METHODS
Twenty-eight patients (mean age, 50.1 years; 15 men, 13 women) were examined between January 2000 and January 2004 with a mean follow-up of 17 months for survival, rejection, and renal function.


RESULTS
Four patients died at 2, 5, 8, and 18 months after LDLT from sepsis (n = 3) and recurrent hepatocellular carcinoma (n = 1). There were no retransplants; hence, patient and graft survival rates were the same (82.4%). Three patients (10.7%) experienced acute cellular rejection requiring treatment. The mean serum creatinine level prior to LDLT was 0.9 +/- 0.4 mg/dL, which remained stable throughout the study. One patient required hemodialysis during the perioperative period for 8 days.


CONCLUSIONS
In the current study, we demonstrate a new strategy of IV MMF administration with low-dose tacrolimus that provides for lower rates of acute rejection, better preservation of renal function, and one that is better tolerated compared with historical treatments after LTx.
Jain
Ashok
A
Department of Surgery, Division of Transplantation, University of Rochester Medical Center, Box SURG, Rochester, NY 14642, USA. ashok_jain@urmc.rochester.edu
Mohanka
Ravi
R
Orloff
Mark
M
Abt
Peter
P
Kashyap
Randeep
R
Kelley
Mark
M
Burlee
Kari
K
Bozorgzadeh
Adel
A
D000284:Administration, Oral; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007674:Kidney Diseases / Q000209:etiology / Q000276:immunology; D016031:Liver Transplantation / Q000009:adverse effects / Q000276:immunology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016019:Survival Analysis; D016559:Tacrolimus / Q000008:administration & dosage*
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus