title: Two yr mycophenolate mofetil plus low-dose calcineurin inhibitor for renal dysfunction after liver transplant.
abstract: We assessed the efficacy and outcome of low through level of calcineurin inhibitors (CNI) and introducing mycophenolate mofetil (MMF) in liver transplant (LT) patients with CNI-related renal dysfunction. Thirty LT patients were converted to combined therapy and compared with 30 patients used as a contemporary control group receiving CNI only. The two groups were matched for sex, age, months after LT, immunosuppressive treatment, creatinine level, presence of diabetes and calculated glomerular filtration rate (GFR) via Cockroft-Gault method. After two years, in the MMF serum creatinine decreased from 1.65 mg/dL (range 1.33-3.5) to 1.4 mg/dL (range 0.9-4.7) (p = 0.002) and GFR increased from 51 mL/min (range 18.9-72.2) to 57.6 mL/min (range 16-92.2) (p < 0.001), whereas the controls not showed any improvement. The logistic regression models employing improvement of creatinine and GFR of at least 10% with respect to baseline as dependent variables showed the use of MMF (p = 0.004 and p = 0.019, respectively) as the only statistically significant parameter. Multiple linear regression analysis identified only MMF as independent predictor of Deltacreatinine and DeltaGFR (p = 0.002 and p < 0.001, respectively). No rejection episode was observed (three in controls). This study demonstrates the medium-term efficacy and safety of MMF plus low dose CNI in reducing nephrotoxicity in LT recipients.
authors.affiliation: Semeiotica Medica, Dipartimento di Medicina Clinica, Universitàdi Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Biselli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Vitale
authors.forename: Annagiulia
authors.initials: A
authors.lastname: Gramenzi
authors.forename: Anna
authors.initials: A
authors.lastname: Riili
authors.forename: Sonia
authors.initials: S
authors.lastname: Berardi
authors.forename: Carlo
authors.initials: C
authors.lastname: Cammà
authors.forename: Alessandra
authors.initials: A
authors.lastname: Scuteri
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Morelli
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.forename: Pietro
authors.initials: P
authors.lastname: Andreone
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
mesh_terms: D000328:Adult; D000368:Aged; D065095:Calcineurin Inhibitors; D003404:Creatinine / Q000097:blood; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D007677:Kidney Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016559:Tacrolimus / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D065095:Calcineurin Inhibitors; D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid; D016559:Tacrolimus