title: Switching from mycophenolate mofetil to enteric-coated mycophenolate sodium in liver transplant patients with gastrointestinal complications.
abstract: OBJECTIVE
  Our aim was to safely and effectively reduce adverse gastrointestinal (GI) events resulting from the use of mycophenolate mofetil (MMF) in liver transplant patients by switching to enteric-coated mycophenolate sodium (EC-MPS).
  
  
  METHODS
  We studied 19 patients on maintenance therapy presenting with GI intolerance to MMF whose therapy was switched to EC-MPS. The variables recorded were: calcineurin inhibitor (CNI) dose levels, MMF/EC-MPS dose levels, lipid profile, hematology, renal and hepatic function markers, and rejection episodes. These variables were recorded at the visit prior to the day of conversion, on the day of conversion, and 1, 3, 6, and 9 months thereafter.
  
  
  RESULTS
  Of the 19 patients, 16 were men (mean age, 56.6 +/- 15.9 years) and 3 were women (58.3 +/- 12.1 years). While 31.6% were on MMF monotherapy, 52.6% were on combined therapy with tacrolimus and 15.8% with cyclosporine. On the day of conversion, 21% were not on MMF, 36.8% were on 1000 mg/d, 26.3% were on 1500 mg/d, 5.3% were on 750 mg/d, and 10.6% were on 500 mg/d. The starting daily doses of EC-MPS were: 360 mg (26.3%), 720 mg (31.6%), 540 mg (26.3%), 1080 mg (10.5%), and 1440 mg (5.3%). GI complications were significantly reduced from the first month postconversion (P < .01), as 57.2% of patients did not display any symptoms; however, at 9 months, this incidence rose by 12% relative to month 1 (P < .05). There were no changes in the other variables and there were no reported rejection episodes. Treatment was suspended in 2 patients due to dyspnea and nervousness.
  
  
  CONCLUSIONS
  In liver transplant patients with GI complications from chronic MMF use, the use of EC-MPS was safe and efficacious, as it significantly reduced their incidence.
authors.affiliation: Hepatobiliopancreatic Surgery and Liver Transplant Unit, Virgen del Rocío University Hospital, 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: L M
authors.initials: LM
authors.lastname: Marín-Gómez
authors.forename: G
authors.initials: G
authors.lastname: Suárez-Artacho
authors.forename: C
authors.initials: C
authors.lastname: Bernal-Bellido
authors.forename: D
authors.initials: D
authors.lastname: Domínguez-Usero
authors.forename: L
authors.initials: L
authors.lastname: Tallón-Aguilar
authors.forename: F
authors.initials: F
authors.lastname: Pareja-Ciuró
authors.forename: J M
authors.initials: JM
authors.lastname: Sousa-Martín
authors.forename: I
authors.initials: I
authors.lastname: García-González
authors.forename: M A
authors.initials: MA
authors.lastname: Gómez-Bravo
mesh_terms: D000328:Adult; D000368:Aged; D016572:Cyclosporine / Q000627:therapeutic use; D003967:Diarrhea / Q000139:chemically induced / Q000453:epidemiology; D004359:Drug Therapy, Combination; D005260:Female; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D015994:Incidence; D016031:Liver Transplantation / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors
chemical_list: D007166:Immunosuppressive Agents; D016572:Cyclosporine; D009173:Mycophenolic Acid; D016559:Tacrolimus