Efficacy and Safety of Mycophenolate Mofetil Monotherapy in Liver Transplant Patients With Renal Failure Induced by Calcineurin Inhibitors

Mycophenolate mofetil monotherapy in liver transplant recipients

“…This is lower than the cumulative rate of rejection (12%) in reported studies to date, although individual rates of rejection have varied significantly, ranging from 3% to as high as 60% (18, 25). Our study differs in that the taper of CNI was comparable (median 6.9 months) to previously reported studies with extended tapers (21, 25, 29, 30). In our study, the mean taper of the two patients who experienced rejection was 5.1 months compared to 15.0 months in the remaining study population.…”

“…Long-term data on CNI sparing regimens effect on renal function have been limited, although it is clear that cumulative CNI dose correlates with progression to chronic renal failure (37). In our study, improvement in renal function was noted in 76% of our patients maintained on MMF monotherapy following an extended duration taper of CNI, a slightly greater percentage than reported in previous studies (61-70%) (21,23). Improvement in renal function was noted initially at one month following complete CNI withdrawal in all patients with sustained improvement noted at last follow-up (median 48.1 months) only in those patients with milder baseline renal dysfunction, suggesting that longterm benefit is greatest in this subgroup.…”

“…In addition, MPA levels were not measured either prior to conversion or while on MMF monotherapy, as these were not clinically available. Two prospective studies have demonstrated low rates of rejection (0% and 6%) with therapeutic levels of MPA, suggesting that pharmacokinetic monitoring may be beneficial (21, 23). Ongoing investigation has identified significant individual variability in dose‐dependent MPA levels, further highlighting the importance of MPA monitoring in patients on MMF (39).…”

“…Initially found to be efficacious as an adjunct to CNI in renal and cardiac transplant recipients, MMF has more recently been used to minimize side effects of CNI in LT recipients, particularly nephrotoxicity, by allowing for dose reduction or even withdrawal of CNI. While two initial prospective randomized trials of MMF monotherapy showed concerning rates of rejection and graft loss, subsequent retrospective and prospective studies have demonstrated lower rates of rejection, although long-term data are limited (13,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). In the present study, we report a slow CNI tapering protocol to MMF monotherapy associated with long-term improvement in renal function, reduced CNI-related side effects, and a low rate of rejection.…”

The renal benefit of mycophenolate mofetil after liver transplantation

“…These effects may be because of the reduction of transforming growth factor‐beta (TGF‐β) and the subsequent anti‐fibrotic effects from MMF administration (19–21). Conversion from CNI therapy to MMF monotherapy has also been shown to maintain or improve measures of renal function, although an increased risk of graft failure owing to rejection with this strategy may be prohibitive (22–27). However, data reporting the benefits of adjunctive MMF immediately post‐transplant (before development of CNI toxicity) are limited.…”