Use of mycophenolate mofetil in liver transplantation: Andalusian Liver Registry.
OBJECTIVE
To evaluate the safety and efficacy of various immunosuppressant regimens using mycophenolate mofetil (MMF).


METHODS
This prospective, observational, multicenter study of 226 patients undergoing liver transplantation was carried out in 2005-2006, with 24-month follow-up. Studied variables were as follows: indicators of kidney, liver, and blood function; intercurrent infections; cardiovascular risk; acute and chronic episodes of rejection; recurrent hepatitis C virus infection; de novo tumors; and survival. Patients were classified into 4 groups according to treatment: no MMF (group 1, n = 91); MMF from induction (group 2, n = 83); late administration of MMF (group 3, n = 30); and MMF at induction, with early withdrawal (group 4, n = 22).


RESULTS
Biodemographic characteristics were similar in all 4 groups. The MMF groups were at higher risk and had worse Model for End-Stage Liver Disease and Child-Pugh scores and worse pretransplantation blood and kidney function values. Significant differences were observed in creatinine concentration between groups 2 and 3: 0.45 mg/dL at 1 month (P < .01), 0.27 mg/dL at 3 months (P < .01), and 0.3 mg/dL at 6 months (P < .05). In contrast, differences of 0.34 mg/dL (P < .01) were observed between groups 1 and 3 at 1 month and 0.17 mg/dL (P < .05) between groups 1 and 2 at 3 months. No differences were noted in white blood cell counts, episodes of acute rejection (19%) and chronic rejection (5%), graft survival (80%), and rate of recurrent hepatitis C virus infection (75%) between the 4 groups. The infection rate at 3 months in groups 2 and 4 was 34.5%, and in groups 1 and 3 was 34.5% (P < .05).


CONCLUSIONS
Use of MMF at induction and introduction of MMF in the first 3 months posttransplantation helps to preserve and restore creatinine levels in patients with worsened kidney function, and aids in keeping them stable, without increasing the risk of rejection while optimizing the anticalcineurin dosage.
Barrera-Pulido
L
L
Hepatobiliary-Pancreatic Surgery and Liver Transplantation Unit, Virgen del Rocio University Hospital, Seville, Spain. lydiabarrera@hotmail.com
Marin
D
D
de la Mata
M
M
López-Garrido
M A
MA
Gómez-Bravo
M A
MA
Jiménez
M
M
Nuñez
F
F
Noguera
F
F
D003404:Creatinine / Q000097:blood; D004334:Drug Administration Schedule; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016031:Liver Transplantation / Q000276:immunology* / Q000502:physiology / Q000706:statistics & numerical data; D009173:Mycophenolic Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D012042:Registries; D013030:Spain; D013997:Time Factors; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D003404:Creatinine; D009173:Mycophenolic Acid