title: Mycophenolate mofetil in combination with reduction of calcineurin inhibitors for chronic renal dysfunction after liver transplantation.
abstract: The purpose of the study was to introduce mycophenolate mofetil (MMF) in liver transplant recipients with renal dysfunction to decrease calcineurin inhibitor (CNI) dosages without increasing rejection risk. In this prospective, multicenter, randomized study, chronic CNI-related renal dysfunction was defined by an increase in serum creatinine with values >140 micromol/L and <300 micromol/L. Patients were randomized in 2 groups.
  
  
  METHODS
  combination of MMF (2 to 3 g/day) and reduced dose of CNI >or=50% of initial dose; control group: no MMF, but with the ability to reduce CNI doses, but not below 75% of initial dose. Fifty-six patients were included, 27 in the study group and 29 in the control group. In the study group, there was a significant decrease in serum creatinine values, from 171.7 +/- 24.2 micromol/L at day 0 to 143.4 +/- 19 micromol/L at month 12 and a significant increase in creatinine clearance, from 42.6 +/- 10.9 mL/min to 51.7 +/- 13.8 mL/min. No rejection episode was observed in the study group. In the control group, there was no improvement of renal function, assessed by the changes in serum creatinine values, from 175.4 +/- 23.4 micromol/L at day 0 to 181.6 +/- 63 micromol/L at month 12, and in creatinine clearance, from 42.8 +/- 12.8 mL/min to 44.8 +/- 19.7 mL/min. The differences between the 2 groups were significant: P = 0.001 for serum creatinine, and P = 0.04 for creatinine clearance. In conclusion, the introduction of MMF combined with the reduction of at least 50% of CNI dose allowed the renal function of liver transplant recipients to significantly improve at 1 year, without any rejection episode and without significant secondary effects.
authors.affiliation: Liver Transplant Unit, Centre Hospitalier Universitaire (CHU) Saint Eloi, Montpellier, France. gp-pageaux@chu-montpellier.fr
authors.forename: Georges-Philippe
authors.initials: GP
authors.lastname: Pageaux
authors.forename: Lionel
authors.initials: L
authors.lastname: Rostaing
authors.forename: Yvon
authors.initials: Y
authors.lastname: Calmus
authors.forename: Christophe
authors.initials: C
authors.lastname: Duvoux
authors.forename: Claire
authors.initials: C
authors.lastname: Vanlemmens
authors.forename: Jean
authors.initials: J
authors.lastname: Hardgwissen
authors.forename: Pierre-Henri
authors.initials: PH
authors.lastname: Bernard
authors.forename: Eric
authors.initials: E
authors.lastname: Barbotte
authors.forename: Lucille
authors.initials: L
authors.lastname: Vercambre
authors.forename: Michael
authors.initials: M
authors.lastname: Bismuth
authors.forename: Pierre
authors.initials: P
authors.lastname: Puche
authors.forename: Françis
authors.initials: F
authors.lastname: Navarro
authors.forename: Dominique
authors.initials: D
authors.lastname: Larrey
mesh_terms: D000368:Aged; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood / Q000652:urine; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000188:drug therapy*; D008099:Liver / Q000502:physiology; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy*
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid