The management of liver transplant recipients with renal function impairment remains controversial because cyclosporine withdrawal from triple immunosuppression regimens may be followed by graft rejection. A nonnephrotoxic and powerful immunosuppressant such as mycophenolate mofetil (MMF) could allow a reduction of cyclosporine dosage or its withdrawal and an improvement in renal function in these patients. Eleven patients with serum creatinine levels greater than 1.5 mg/dL, normal graft function, and a rejection-free period of at least 1 year started MMF at a dose of 2000 mg/d (reduced in case of adverse events) while cyclosporine dosage was slowly reduced. At last follow-up (63 ؎ 5 weeks), 7 patients remained free of cyclosporine (6 of those patients are also free of steroids), 2 patients reduced their cyclosporine dose, and 2 patients developed mild acute rejection that responded to a switch to tacrolimus therapy. Serum creatinine and urea levels in the 7 patients free of cyclosporine decreased from 2.22 ؎ 0.13 to 1.90 ؎ 0.19 mg/dL (P ‫؍‬ .05) and 0.95 ؎ 0.10 to 0.60 ؎ 0.10 g/L (P F .001), respectively. Creatinine clearance increased from 38.16 ؎ 5.60 to 47.01 ؎ 6.76 mL/min (P ‫؍‬ .005). Control of arterial hypertension also improved. Tolerance to MMF was good, but 6 patients required dose reductions, mainly because of asymptomatic anemia. In conclusion, in liver transplant recipients with stable graft function, MMF may allow cyclosporine dose reduction or discontinuation, thus improving renal function and the control of arterial hypertension. This change of treatment must be carefully monitored because of the frequent need for MMF dose reduction and the risk for rejection.

Liver cirrhosis is frequently associated with diabetes mellitus (DM), and this metabolic complication is also frequent after orthotopic liver transplantation (OLT). The aim of our study is to investigate which factors are associated with DM before and after OLT and their impact on post-OLT evolution. We evaluated the prevalence of DM among 115 liver transplant candidates with cirrhosis and assessed their evolution after OLT (median follow-up, 41 months). Sixteen candidates had DM requiring pharmacological therapy (group A), 45 candidates had DM controlled with diet (group B), and 54 candidates did not have DM (group C). One-year and 3-year actuarial survival rates were 100% and 100% for group A, 91% and 85% for group B, and 77% and 74% for group C, respectively (P < .03). Post-OLT DM was more frequent in group A. The incidence of other metabolic complications, major infections, rejection, and arterial hypertension; the need for hospitalization; and renal and graft function of patients in groups A, B, and C were similar. The only risk factor for DM 1 year after OLT on multivariate analysis was pre-OLT DM requiring pharmacological treatment. L iver cirrhosis is frequently associated with impaired glucose metabolism. 1-3 Insulin resistance has been found in most patients with cirrhosis. 4-6 It seems to be caused mainly by a deficiency in insulin-stimulated glycogen synthesis in the muscle. 4 This insulin resistance increases the demand for pancreatic insulin secretion and may lead to overt diabetes mellitus (DM), 7 found in 10% to 30% of the patients with cirrhosis.Glucose intolerance and insulin resistance of patients with cirrhosis are reversed after orthotopic liver transplantation (OLT), 8 but the use of such immunosuppressive drugs as cyclosporine, tacrolimus, or prednisone can alter glucose metabolism either by direct effect on pancreatic ␤-cells or by contributing to insulin resistance. 9-11 Thus, the global effect of OLT on glucose metabolism may be both prodiabetogenic and antidiabetogenic.Some studies have reported the evolution of transplant recipients with DM after OLT. [12][13][14][15][16][17] In 1 study, 13 liver transplant recipients with DM had a lower survival rate than those without DM. Conversely, other studies did not show a difference between patients with and without DM. 12,[14][15][16][17] In these studies, DM had been diagnosed according to serum fasting glucose levels, probably underestimating the incidence of liver cirrhosis-related DM.The aim of this study is to investigate the prevalence of pre-OLT DM in end-stage liver cirrhosis and assess the evolution of patients with DM after OLT. In addition, factors predisposing to post-OLT DM were studied. Patients and Methods Study Design and PopulationFrom February 1990 to October 1998, a total of 115 adult patients with liver cirrhosis undergoing OLT at a single institution were studied before OLT by means of an oral glucose tolerance test (OGTT) to rule out DM, unless they had a previous reported diagnosis of DM. According to the 1997 recommen...

Hepatic graft rejection is a common complication after liver transplantation (LT), with a maximum incidence within the first weeks. The identification of high-risk patients for early acute rejection (EAR) might be useful for clinicians. A series of 133 liver graft recipients treated with calcineurin inhibitors was retrospectively assessed to identify predisposing factors for EAR and develop a mathematical model to predict the individual risk of each patient. The incidence of EAR (<45 days after LT) was 35.3%. Multivariate analysis showed that recipient age, underlying liver disease, and Child's class before LT were independently associated with the development of EAR. Combining these 3 variables, the following risk score for

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