title: Mycophenolate mofetil monotherapy in patients who underwent liver transplantation for hepatitis C cirrhosis.
abstract: BACKGROUND
  Mycophenolate mofetil (MMF) monotherapy has recently been proposed for liver transplant recipients with adverse events (nephrotoxicity, hypertension) related to calcineurin inhibitors. We analyzed the influence of MMF on the clinical course of recurrent hepatitis C.
  
  
  METHODS
  Among 1038 patients who underwent liver transplantation (OLT) from April 1986 to October 2006, we analyzed 48 adult recipients (4.6%) whose diagnosis was hepatitis C virus (HCV) cirrhosis and who were converted from calcineurin inhibitors to MMF monotherapy.
  
  
  RESULTS
  The 36 men and 12 women, had a mean age at OLT of 52.9 +/- 7.2 years; the time elapsed from OLT to the onset of MMF monotherapy was 72.5 +/- 47.6 months (range = 11-210). The mean follow-up after monotherapy was 19 +/- 16.1 months (range = 2-67). Indications for conversion were: chronic renal dysfunction with HCV in 45 patients; HCV recurrence in two; and hypertension plus HCV recurrence in one subject. When the indication was renal dysfunction (excluding three patients who underwent hemodialysis), the mean creatinine values decreased significantly from baseline to 6 months of monotherapy from 1.63 +/- 0.61 mg/dL to 1.51 +/- 0.78 mg/dL (P < .03). The creatinine clearance only improved significantly from the baseline value of 56.6 +/- 16.8 mL/min to the value at 3 months of monotherapy-63.6 +/- 18.4 mL/min (P < .001). At the last outpatient visit, creatinine and creatinine clearances had not changed significantly. The mean diastolic blood pressure did improve significantly at the end of the study. The mean glucose levels decreased but not significantly at the last outpatient visit. Liver function tests did not change significantly after conversion to MMF monotherapy. The acute rejection rate was 8.3%, and adverse events related to MMF monotherapy were present in 9 patients (18.7%).
  
  
  CONCLUSIONS
  Conversion from calcineurin inhibitors to MMF monotherapy in patients who underwent OLT for HCV transiently improved renal function and hypertension. The acute rejection rate was low, and adverse events were usually well tolerated.
authors.affiliation: Alejandro Manrique Municio, Hospital Doce de Octubre, Servicio de Cirugía General, Madrid, Spain. ammunicio@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Manrique
authors.forename: C
authors.initials: C
authors.lastname: Jiménez
authors.forename: P
authors.initials: P
authors.lastname: Ortega
authors.forename: M
authors.initials: M
authors.lastname: Abradelo
authors.forename: A
authors.initials: A
authors.lastname: Gimeno
authors.forename: J
authors.initials: J
authors.lastname: Calvo
authors.forename: F
authors.initials: F
authors.lastname: Cambra
authors.forename: R L
authors.initials: RL
authors.lastname: -Sterup
authors.forename: J M
authors.initials: JM
authors.lastname: Morales
authors.forename: E
authors.initials: E
authors.lastname: Moreno
mesh_terms: D000328:Adult; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006526:Hepatitis C / Q000601:surgery*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008103:Liver Cirrhosis / Q000601:surgery* / Q000821:virology*; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid