Mycophenolate mofetil monotherapy in liver transplantation

Stewart, SF; Hudson, Mark; Talbot, David; Manas, Derek; Day, CP

doi:10.1016/s0140-6736(00)04065-4

Cited by 118 publications

(103 citation statements)

References 3 publications

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“…In our experience, episodes of graft rejection were well controlled with an increase in CI, 10 but others have observed a poor responses. 12 In the present paper, two patients (18%) developed a rejection episode, both of which responded to increases in CI. No patient required steroid therapy.…”

Section: Discussionsupporting

confidence: 50%

Conversion from calcineurin inhibitors to mycophenolate mofetil in liver transplant recipients with diabetes mellitus

Herrero¹,

Quiroga²,

Sangro³

et al. 2003

Transplantation Proceedings

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Diabetes mellitus, a frequent metabolic complication in liver transplant recipients, may be produced by the diabetogenic effect of calcineurin inhibitors cyclosporine and tacrolimus. The aim of this study was to investigate the safety and metabolic effects of a gradual switch from cyclosporine or tacrolimus to mycophenolate mofetil among 12 diabetic liver transplant recipients. One patient was withdrawn from the study due to gastrointestinal side effects. Of the 11 remaining patients, cyclosporine or tacrolimus was completely withdrawn in five patients. Two patients developed suspected acute rejection episodes that were controlled by increasing the tacrolimus dosage. Glycosylated hemoglobin A1C and C-peptide levels were significantly lower at 3 and 6 months after the initiation of mycophenolate mofetil (P < .03 in all cases). Furthermore, urea and uric acid levels were significantly reduced after the change of treatment. In conclusion, a switch from cyclosporine/tacrolimus to mycophenolate mofetil may produce beneficial metabolic effects in diabetic liver transplant recipients, but poses a risk of graft rejection. I D ABETES MELLITUS (DM) is a frequent metabolic complication in liver transplant(LT) recipients. Despite the lack of universal agreement, some studies have observed worsened short-and mid-term survival among diabetic LT recipients. 1-7 Furthermore, DM is a wellknown risk factor for cardiovascular disease, which is one of the leading causes of death of LT recipients in the long term. 8 Calcineurin inhibitors (CI) also predispose to DM through islet cell toxicity, diminished insulin synthesis or release, as well as decreased peripheral insulin sensitivity. 9 Mycophenolate mofetil (MMF) has proven to be useful as a CI-sparing agent. The use of MMF has allowed physicians to reduce cyclosporine exposure in LT recipients with renal functional impairment. 10 Some patients have been maintained on MMF monotherapy, but this strategy poses the risk of graft rejection. 11 The aim of the present study was to examine whether conversion to MMF for stable LT recipients with DM allows the reduction/withdrawal of CI and results in improve metabolic control.From the Liver Unit (J.I.H., J.Q., B.S., J.P.) and

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Section: Discussionsupporting

confidence: 50%

Conversion from calcineurin inhibitors to mycophenolate mofetil in liver transplant recipients with diabetes mellitus

Herrero¹,

Quiroga²,

Sangro³

et al. 2003

Transplantation Proceedings

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“…12 Main advantage of MPA is lack of nephrotoxicity, so it can be combined with CNI, thus permitting lower doses of CNIs. 22,23 When given alone (without CNIs), use of MPA resulted in higher rates of rejection compared to the CNIs. 23 Adverse events related to MPA use are gastrointestinal and bone marrow suppression (leucopenia and thrombocytopenia).…”

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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“…Mycophenolic acid emerged as a new immunosuppressive agent in the early 1990s with a mechanism of action different from CNI (Mele et al, 2000) (Stewart et al, 2001). Whereas cyclosporine and tacrolimus both inhibit the enzyme calcineurin and the induction of cytokine synthesis soon after T cell activation, mycophenolic acid has no direct effect on the production of cytokines but prevents T and B cell proliferation by inhibiting a pathway required for cell division.…”

Section: Mycophenolic Acidmentioning

confidence: 99%