title: Mycophenolate mofetil use is associated with decreased risk of late acute rejection in adult liver transplant recipients.
abstract: Mycophenolate mofetil (MMF) used in a triple-drug regimen has been shown to decrease acute rejection rates, compared to a double-drug regimen. The impact of MMF on late acute rejection (LAR) episodes has not been well described. To investigate the risk of LAR (rejection > or = 6 months post-transplantation) data from the Scientific Registry of Transplant Recipients (SRTR) were used. We studied adult primary liver transplant recipients transplanted between June 1, 1995, and April 30, 2004, with hepatitis C virus (HCV) (n = 3356), hepatitis B virus (HBV) (n = 550) or a nonviral (n = 5740) primary cause of liver disease who were recorded as receiving continuous 3-(MMF + Tacro + steroids) versus 2-drug (Tacro + steroids) therapy for at least 6 months immediately post transplantation. Kaplan-Meier analysis showed significantly lower LAR rates 4 years post-transplant in 3- versus 2-drug HCV, HBV and nonviral disease patients. Multivariate regression confirmed 3- versus 2-drug therapy to be associated with a decreased risk of LAR. Late graft survival was significantly lower at 4 years post-transplant for patients with LAR 6-12 months post-transplantation versus patients with early rejection (78.0% vs. 87.0%, p < 0.001) and no rejection (88.1%, p < 0.001). Three-drug versus 2-drug therapy for a minimum of 6 months may offer a better treatment strategy to avoid the consequences and expense of LAR episodes.
authors.affiliation: Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA. rwiesner@mayo.edu
authors.forename: R H
authors.initials: RH
authors.lastname: Wiesner
authors.forename: B J
authors.initials: BJ
authors.lastname: Steffen
authors.forename: K M
authors.initials: KM
authors.lastname: David
authors.forename: A H
authors.initials: AH
authors.lastname: Chu
authors.forename: R D
authors.initials: RD
authors.lastname: Gordon
authors.forename: J R
authors.initials: JR
authors.lastname: Lake
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000276:immunology / Q000473:pathology* / Q000517:prevention & control*; D016174:Hepacivirus / Q000187:drug effects / Q000502:physiology; D006509:Hepatitis B / Q000188:drug therapy / Q000276:immunology / Q000601:surgery / Q000821:virology; D006515:Hepatitis B virus / Q000187:drug effects / Q000502:physiology; D006526:Hepatitis C / Q000188:drug therapy / Q000276:immunology / Q000601:surgery / Q000821:virology; D006801:Humans; D016031:Liver Transplantation / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000494:pharmacology; D012307:Risk Factors; D013997:Time Factors
chemical_list: D009173:Mycophenolic Acid