title: Mycophenolate mofetil promotes prolonged improvement of renal dysfunction after pediatric liver transplantation: experience of a single center.
abstract: Few studies have evaluated the long-term use of MMF in liver transplanted children with renal dysfunction. The aim of this study is to report the experience of a pediatric transplantation center on the efficacy and security of long-term use of a MMF immunosuppressant protocol with reduced doses of CNIs in stable liver transplanted children with renal dysfunction secondary to prolonged use of CsA or Tac. Between 1988 and 2003, 191 children underwent OLT and 11 patients developed renal dysfunction secondary to CNIs toxicity as evaluated by biochemical renal function parameters. The interval between liver transplantation and the introduction of the protocol varied from one to 12 yr. Renal function was evaluated by biochemical parameters in five phases: immediately prior to MMF administration; 3, 6, 12 and 24 months after the introduction of MMF. Among the patients, nine of them (82%) showed improvement of renal function parameters in comparison with the pretreatment values. The two patients that did not show any improvement were patients in whom the interval of time between OLT and the introduction of MMF was longer. All parameters of liver function remained unchanged. No episodes of acute or chronic rejection or increases in infection rates during the period were detected. Two patients developed transitory diarrhea and leukopenia that were reverted with reduction of MMF dosage. In conclusion, in liver transplanted pediatric patients with CNI-induced chronic renal dysfunction, the administration of MMF in addition to reduced doses of CNIs promotes long-term improvement in renal function parameters with no additional risks.
authors.affiliation: Liver Transplantation Unit, Children Institute, Hospital das Clinicas, University of Sao Paulo, Sao Paulo, Brazil. uenist@usp.br
authors.forename: Uenis
authors.initials: U
authors.lastname: Tannuri
authors.forename: Nelson E M
authors.initials: NE
authors.lastname: Gibelli
authors.forename: João G
authors.initials: JG
authors.lastname: Maksoud-Filho
authors.forename: Maria M
authors.initials: MM
authors.lastname: Santos
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Pinho-Apezzato
authors.forename: Manoel Carlos P
authors.initials: MC
authors.lastname: Velhote
authors.forename: Ali A R
authors.initials: AA
authors.lastname: Ayoub
authors.forename: Marcos M
authors.initials: MM
authors.lastname: Silva
authors.forename: João G
authors.initials: JG
authors.lastname: Maksoud
mesh_terms: D000293:Adolescent; D001806:Blood Urea Nitrogen; D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood / Q000378:metabolism; D016572:Cyclosporine / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007674:Kidney Diseases / Q000188:drug therapy*; D007677:Kidney Function Tests; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D011183:Postoperative Complications / Q000188:drug therapy*; D012189:Retrospective Studies; D016559:Tacrolimus / Q000627:therapeutic use; D014527:Uric Acid / Q000097:blood; D014611:Vaccination
chemical_list: D007166:Immunosuppressive Agents; D014527:Uric Acid; D016572:Cyclosporine; D003404:Creatinine; D009173:Mycophenolic Acid; D016559:Tacrolimus