Improvement of Acute and Chronic Renal Dysfunction in Liver Transplant Patients After Substitution of Calcineurin Inhibitors by Mycophenolate Mofetil

Barkmann, Annette; Nashan, Björn; Schmidt, Hartmut; Böker, K. H. W.; Emmanouilidis, Nikos; Rosenau, Jens; Bahr, Matthias J.; Hoffmann, Matthias; Manns, Michael P.; Klempnauer, Jürgen; Schlitt, Hans J.

doi:10.1097/00007890-200005150-00025

Cited by 101 publications

(88 citation statements)

References 12 publications

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“…Previous reports support the use of MMF in combination with CNI reduction (14)(15)(16)(17) or withdrawal (16,(18)(19) in the management of patients with CNI-related chronic renal dysfunction (14)(15)(16)(17) with good results in terms of improvement of renal function. However, there are few reports on CNI withdrawal and MMF monotherapy, and these were in small series with a short follow up (16,(18)(19).…”

Section: Introductionmentioning

confidence: 90%

“…However, CNIs exhibit a broad spectrum of nonimmunological side-effects, including chronic renal dysfunction, arterial hypertension, diabetes mellitus and hyperuricemia (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11), which are frequent causes of longterm morbidity and mortality after surgery. With the aim of reducing the incidence and severity of CNI side-effects, progressive CNI dose reduction and withdrawal, with or without additional immunosuppression, has been attempted in transplant recipients with different results (12)(13)(14)(15)(16)(17)(18)(19).…”

Section: Introductionmentioning

confidence: 99%

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Mycophenolate Mofetil Can Be Used as Monotherapy Late After Liver Transplantation

Planas¹,

Cuervas-Mons²,

González³

et al. 2004

American Journal of Transplantation

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We report our experience with calcineurin inhibitor (CNI) withdrawal and MMF monotherapy in 50 adult liver transplant (OLT) recipients with CNI-related toxicity. Thirty-four patients had chronic renal dysfunction (CRD) associated with arterial hypertension, 11 had only CRD and other five patients had hypertension. The mean time between OLT and introduction of MMF was 81 months. After the introduction of MMF, CNI was progressively reduced and withdrawn if possible. At the end of the follow up (mean time: 18 months) CNI was withdrawn in 39 patients (78%), and there was a significant decrease from baseline in serum creatinine (1.81-1.49 mg/dL; p < 0.0001), BUN (76.6-52.8 mg/dL; p < 0.0001) and uric acid (9-7.5 mg/dL; p < 0.0001) levels, and an increase in creatinine clearance (44.7-55.1 mL/min; p < 0.0001). Excluding patients who developed graft rejection and two patients who died, CRD improved in 32 of 40 patients (80%), and arterial hypertension improved in 22 of 29 patients (76%). Five patients (10%) developed acute rejection, and one patient (2%) chronic rejection. Twenty-six patients (52%) experienced side-effects, with asthenia, herpes virus infection, and diarrhea being the most common. Only eight patients (16%) required MMF dose reduction. In conclusion, MMF monotherapy late after OLT improves CRD and hypertension in most patients, is safe and well tolerated.

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Section: Introductionmentioning

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Mycophenolate Mofetil Can Be Used as Monotherapy Late After Liver Transplantation

Planas¹,

Cuervas-Mons²,

González³

et al. 2004

American Journal of Transplantation

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“…MPA inhibits inosine 5 0 monophosphate dehydrogenase (rate limiting enzyme in the de novo synthesis of guanosine nucleotides). 21 Thus administration of MPA results in blockade of lymphocyte proliferation. 12 Main advantage of MPA is lack of nephrotoxicity, so it can be combined with CNI, thus permitting lower doses of CNIs.…”

Section: Antimetabolitesmentioning

confidence: 99%

Current Status of Immunosuppression in Liver Transplantation

Choudhary

Saigal

Shukla

et al. 2013

Journal of Clinical and Experimental Hepatology

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With advancements in immunosuppressive strategies and availability of better immunosuppressive agents, survival rate following liver transplantation has improved significantly in the recent times. Besides improvements in surgical techniques, the most important factor that has contributed to this better outcome is the progress made in the field of immunosuppression. Over the last several years, the trend has changed to tailored immunosuppression with the aim of achieving optimal graft function while avoiding its undesirable side effects. Induction agents are no longer used routinely and the aim is to provide minimal immunosuppression in the maintenance phase. The present review discusses the various types of immunosuppressive agents, their mechanism of action, clinical utility, advantages and disadvantages, and their side effects in short and long-term. It also discusses about tailoring immunosuppression in presence of various situations such as renal dysfunction, metabolic syndrome, hepatitis C recurrence, cytomegalovirus infections and so on. The issue of chronic kidney disease and the available renal sparing immunosuppressive strategies has been particularly stressed upon. Finally, it discusses about the practical aspects of various immunosuppression regimens including drug monitoring. ( J CLIN EXP HEPATOL 2013;3:150-158)

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“…Studies in heart, lung, and liver recipients have shown that serum creatinine and BP can improve when CNI exposure is reduced in concert with MMF addition. [82][83][84] Similarly, in liver recipients in whom immunosuppression requirements are less stringent, emerging data suggest that elimination of CNIs and replacement by MMF may also achieve these goals. 85 In contrast, there is growing recognition that sirolimus is not devoid of nephrotoxicity, as originally hoped.…”

Section: Cni-sparing Therapy With Mycophenolate Mofetil or Sirolimusmentioning

confidence: 99%

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

Bloom

Reese

2007

Journal of the American Society of Nephrology

160

138

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Improvement of Acute and Chronic Renal Dysfunction in Liver Transplant Patients After Substitution of Calcineurin Inhibitors by Mycophenolate Mofetil

Abstract: In patients who undergo liver transplantation, substitution of CNI by MMF leads to improvement of acute as well as chronic renal dysfunction in most cases. Side effects of MMF may be limiting in some patients, and the immunological consequences remain to be studied.

Cited by 101 publications

References 12 publications

Mycophenolate Mofetil Can Be Used as Monotherapy Late After Liver Transplantation

Mycophenolate Mofetil Can Be Used as Monotherapy Late After Liver Transplantation

Current Status of Immunosuppression in Liver Transplantation

Chronic Kidney Disease after Nonrenal Solid-Organ Transplantation

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