title: Efficacy and safety of mycophenolate mofetil monotherapy in liver transplant patients with renal failure induced by calcineurin inhibitors.
abstract: OBJECTIVE
  To assess the efficacy and safety of mycophenolate mofetil (MMF) monotherapy in liver transplant recipients with renal failure secondary to the use of calcineurin inhibitors (CNIs).
  
  
  METHODS
  Thirty-one patients on MMF monotherapy with creatinine levels >1.3 mg/dL, previously immunosuppressed with CNIs and MMF, were analyzed. Conversion was started in patients with no acute or chronic rejection episodes and stable liver chemistry. CNI doses were reduced by 25% every 2 to 3 months, or to 50% if the dose was lower than 1 mg/d of tacrolimus or 50 mg/d of cyclosporine. Different variables were recorded from the time that conversion to monotherapy was decided, on the discontinuation day of the calcineurin inhibitor, and during the follow-up.
  
  
  RESULTS
  Mean times from transplant to conversion ranged from 14 to 186 months. The minimum follow-up time in monotherapy was 12 months. Renal function improved at 6 months in 70% of cases and at 12 months in 69.6%. Patients with no renal function improvement maintained stable creatinine values. There were no rejection episodes, graft losses, or deaths. No leukopenia occurred, and triglyceride and uric acid values improved.
  
  
  CONCLUSIONS
  MMF monotherapy is a safe alternative in patients with posttransplant renal failure secondary to the use of CNIs. Renal function improvement was achieved in almost 70% of patients at 12 months, and creatinine values were maintained in all other patients. The risk of rejection due to the slow tapering of CNIs is minimum.
authors.affiliation: Hepatobiliopancreatic Surgery and Liver Transplant Unit, Virgen del Rocio University Hospitals, Seville, Spain. lydiabarrera@hotmail.com
authors.forename: L
authors.initials: L
authors.lastname: Barrera Pulido
authors.forename: J M
authors.initials: JM
authors.lastname: Alamo Martínez
authors.forename: F
authors.initials: F
authors.lastname: Pareja Ciuró
authors.forename: M A
authors.initials: MA
authors.lastname: Gómez Bravo
authors.forename: J
authors.initials: J
authors.lastname: Serrano Díez-Canedo
authors.forename: C
authors.initials: C
authors.lastname: Bernal Bellido
authors.forename: G
authors.initials: G
authors.lastname: Suárez Artacho
authors.forename: I
authors.initials: I
authors.lastname: García González
authors.forename: J M
authors.initials: JM
authors.lastname: Pascasio Acevedo
authors.forename: A
authors.initials: A
authors.lastname: Bernardos Rodríguez
mesh_terms: D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000378:metabolism; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007677:Kidney Function Tests; D007958:Leukocyte Count; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000276:immunology*; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D051437:Renal Insufficiency / Q000139:chemically induced*; D012189:Retrospective Studies; D012449:Safety; D013997:Time Factors; D017211:Treatment Failure; D014527:Uric Acid / Q000097:blood
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D014527:Uric Acid; D003404:Creatinine; D009173:Mycophenolic Acid