title: Potential immunological advantage of intravenous mycophenolate mofetil with tacrolimus and steroids in primary deceased donor liver transplantation and live donor liver transplantation without antibody induction.
abstract: With the current immunosuppressive regimens, graft loss secondary to immunological reasons after successful liver transplantation is a rarity; acute rejections, however, do occur, with the majority of them being steroid-responsive. The aim of the present study is to examine the rate of acute rejection with tacrolimus, intravenous (IV) mycophenolate mofetil (MMF), and steroids in primary deceased donor liver transplant (DDLT) and live donor liver transplant (LDLT) recipients. During the year 2005, 130 patients (mean age: 54.9 +/- 10.8, males: 84, females: 46, 112 DDLT and 18 LDLT) received primary liver transplantation. They were followed up for the incidence of acute rejection in the first 12 months. Liver biopsies were performed as clinically indicated; protocol liver biopsies were never performed. A total of 127 liver biopsies were performed. Thirty-two had a rejection activity index (RAI) score of > or =3, of which 24 biopsies in 20 patients were not treated with a steroid bolus. Eight (6.1%) patients (mean RAI score: 5.1 +/- 1.4) received 750 to 1500 mg of methylprednisolone over 3 days. Out of these, 2 were noncompliant, 4 were off MMF, and 1 was on cyclosporine. All patients responded to steroid therapy. None of the patients required any antibody preparation. In conclusion, IV MMF with tacrolimus and steroids is useful and required antirejection therapy in 6.1% of liver transplant recipients.
authors.affiliation: Department of Surgery, Division of Solid Organ Transplantation, University of Rochester Medical Center, Rochester, NY 14642, USA. ashok_jain@urmc.rochester.edu
authors.forename: Ashokkumar
authors.initials: A
authors.lastname: Jain
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sharma
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ryan
authors.forename: Georgious
authors.initials: G
authors.lastname: Tsoulfas
authors.forename: Mark
authors.initials: M
authors.lastname: Orloff
authors.forename: Peter
authors.initials: P
authors.lastname: Abt
authors.forename: Randeep
authors.initials: R
authors.lastname: Kashyap
authors.forename: Pam
authors.initials: P
authors.lastname: Batzold
authors.forename: Lisa
authors.initials: L
authors.lastname: Sauberman
authors.forename: Saman
authors.initials: S
authors.lastname: Safadjou
authors.forename: Maureen
authors.initials: M
authors.lastname: Graham
authors.forename: Adel
authors.initials: A
authors.lastname: Bozorgzadeh
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage* / Q000493:pharmacokinetics; D007262:Infusions, Intravenous; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics; D012720:Severity of Illness Index; D016559:Tacrolimus / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008775:Methylprednisolone