Long-Term Outcome of Adding Mycophenolate Mofetil to Tacrolimus for Nephrotoxicity Following Liver Transplantation

Abstract

Mycophenolate mofetil (MMF) has no known nephrotoxicity. This report examines the outcome in patients who received MMF for renal impairment on tacrolimus-based immunosuppression. From 1995 to 1996, twelve liver transplantation (LTx) patients (mean age 54.6 years) with serum creatinine >1.8 mg/dl were included in the study. MMF was introduced and tacrolimus dose was reduced by 30-50%. Each patient was followed for 6 years. Renal function showed improvement in seven patients, deterioration in four, and no change in one patient. Overall mean serum creatinine decreased from 2.5 to 1.9 mg/dl at 6 months but increased to 2.2 mg/dl at 18 to 24 months. After that, renal function remained stable for 72 months. Iothalamate clearance showed 18.5% improvement at 1 year. Three patients developed renal failure. Six patients died in the follow-up period. Addition of MMF with reduced tacrolimus dose resulted in sustained improvement in renal function in 58% of patients.

Sustained Renal Response to Mycophenolate Mofetil and CNI Taper Promotes Survival in Liver Transplant Patients with CNI-Related Renal Dysfunction

“…Adding MMF plus subsequent CNI taper were shown to result in renal improvement within a few months [21][22][23][24][25][26][27][28]. Recently, Biselli et al [29] have reported on sustained efficacy and safety of MMF plus low-dose CNI after 2 years.…”

“…The introduction of MMF followed by a significant CNI dose reduction may, however, result in early renal function improvement without increasing the immunological risk for the patient [21][22][23][24][25][26][27]. The long-term impact of this immunosuppressive protocol on renal function and outcome has not yet been analyzed.…”

“…Subsequently, CNIs were tapered until reaching the target trough concentrations of CsA (60 ± 10 ng/ml) and Tac (5 ± 1 ng/ml) [27]. Liver allograft biopsy was carried out when liver function deteriorated.…”

Old Immunosuppressive Agents: Newer Approach in liver Transplant Recipients to Achieve Rejection Free and Nephron Preserving Protocol

“…Various immunosuppressive approaches have been cited with use of antibody preparation in group of patient with pre-existing renal dysfunction including IL-2 inhibitors and Thymoglobulin [4]. We have in the past published the use of intravenous MMF instead of oral MMF in immediate post-operative period without antibody induction, both to reduce the rate of ACR and preserve renal function [5][6][7]. The rationale for I.V.…”

Liver transplantation—Economics in the less developed world

“…This drug is far more expensive than the CNIs. Use of MMF has been shown to reduce the requirement of CNI drugs, a definite advantage in patients with a low glomerular filtration rate [5]. Such 'nephroprotection' is particularly required in sick patients with an elevated baseline creatinine.…”