title: Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension.
abstract: Although mycophenolate mofetil (MMF) monotherapy has been successfully used in liver transplant recipients suffering from calcineurin-inhibitor (CNI)-related chronic toxicity, still no consensus has been reached on its safety, efficacy and tolerability. We attempted the complete weaning off CNI in 42 individuals presenting chronic renal dysfunction and/or dyslipidemia and/or arterial hypertension and simultaneously introduced 1.5 gm/day MMF. CNI could be completely withdrawn in 41 cases. A total of 32 (75%) patients are currently on <or=1.5 gm/day of MMF. Mean follow-up from the introduction of MMF is 31.5 months and mean length of follow-up from the beginning of MMF monotherapy is 27.3 months. Renal function improved in 31/36 (89%) cases. Blood levels of cholesterol and triglycerides decreased in 13 of 17 (76%) and 15 of 17 (89%) patients, respectively. Arterial hypertension improved in 4 of 5 (80%) cases. A total of 8 patients showed a single episode of fluctuation of liver function tests during tapering off CNI. This feature was interpreted as an acute rejection (AR), based on the resolution of the clinical setting after escalation of MMF daily dose to 2 gm. A further patient developed a biopsy-proven AR insensitive to MMF adjustment, requiring reinstitution of the CNI dose. No deaths or major toxicity requiring MMF discontinuation occurred. In conclusion, low dose MMF monotherapy is safe, effective, and well tolerated.
authors.affiliation: Transplant and General Surgery Unit, S. Eugenio Hospital, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Orlando
authors.forename: Leonardo
authors.initials: L
authors.lastname: Baiocchi
authors.forename: Andrea
authors.initials: A
authors.lastname: Cardillo
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iaria
authors.forename: Nicola
authors.initials: N
authors.lastname: De Liguori Carino
authors.forename: Nicola
authors.initials: N
authors.lastname: De Liguori
authors.forename: Linda
authors.initials: L
authors.lastname: De Luca
authors.forename: Benedetto
authors.initials: B
authors.lastname: Ielpo
authors.forename: Laura
authors.initials: L
authors.lastname: Tariciotti
authors.forename: Mario
authors.initials: M
authors.lastname: Angelico
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tisone
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D002784:Cholesterol / Q000378:metabolism; D050171:Dyslipidemias / Q000188:drug therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000628:therapy*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney / Q000502:physiology*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011446:Prospective Studies; D013997:Time Factors; D014280:Triglycerides / Q000378:metabolism
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D014280:Triglycerides; D002784:Cholesterol; D009173:Mycophenolic Acid