title: Mycophenolate mofetil may induce prolonged severe anemia during pegylated-interferon/ribavirin/simeprevir therapy in liver transplant recipients.
abstract: Aim: Pegylated-interferon/ribavirin/simeprevir (PEG-IFN/RBV/SMV) combination therapy is widely used for hepatitis C virus (HCV) treatment after liver transplantation (LT). Here, we observed two cases of extended severe anemia during PEG-IFN/RBV/SMV therapy for HCV serological type 1 re-infected after LT. Immunosuppressants consisted of tacrolimus and mycophenolate mofetil (MMF). Case 1 was a 65-year-old-woman treated with PEG-IFN/RBV/SMV therapy and 500 mg MMF/day 9 months after LT. Her serum hemoglobin (Hb) level decreased from 10 to 8.4 mg/dL on day 25. Despite discontinuing the PEG-IFN/RBV/SMV treatment on day 32, her Hb level decreased to 5.1 mg/dL on day 40. Case 2 was a 61-year-old-woman started on PEG-IFN/RBV/SMV therapy 20 months after LT. Her serum Hb level decreased from 12.2 to 7.1 mg/dL on day 39. The MMF dose was reduced from 1,500 to 1,000 mg/day, and her Hb level was maintained. Red blood cell transfusions were required in both cases, and anemia persisted for 2 months. These patients had the C/C major type inosine triphosphatase (ITPA) polymorphism. In conclusion, MMF induced severe persistent anemia by co-treatment with IFN/RBV in patients who underwent LT. Thus, the immunosuppressant dose should be chosen carefully for patients with the high-risk ITPA allele.
authors.affiliation: Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan, kogiso.ige@twmu.ac.jp.
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kogiso
authors.forename: Katsutoshi
authors.initials: K
authors.lastname: Tokushige
authors.forename: Etsuko
authors.initials: E
authors.lastname: Hashimoto
authors.forename: Makiko
authors.initials: M
authors.lastname: Taniai
authors.forename: Akiko
authors.initials: A
authors.lastname: Omori
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Kotera
authors.forename: Hiroto
authors.initials: H
authors.lastname: Egawa
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamamoto
authors.forename: Keiko
authors.initials: K
authors.lastname: Shiratori
mesh_terms: D000368:Aged; D000740:Anemia / Q000139:chemically induced* / Q000628:therapy; D000998:Antiviral Agents / Q000627:therapeutic use*; D017707:Erythrocyte Transfusion; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy* / Q000276:immunology; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016898:Interferon-alpha / Q000627:therapeutic use; D016031:Liver Transplantation; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D012008:Recurrence; D012254:Ribavirin / Q000627:therapeutic use; D000069616:Simeprevir / Q000627:therapeutic use; D016559:Tacrolimus / Q000009:adverse effects
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D016898:Interferon-alpha; D012254:Ribavirin; D000069616:Simeprevir; D009173:Mycophenolic Acid; D016559:Tacrolimus