Tacrolimus (Fk506) and Mycophenolate Mofetil Combination Therapy Versus Tacrolimus in Adult Liver Transplantation1

Eckhoff, Devin E.; McGuire, Brendan M.; Frenette, Luc; Contreras, Juan L.; Hudson, Sharon L.; Bynon, John S

doi:10.1097/00007890-199801270-00006

Cited by 103 publications

(67 citation statements)

References 36 publications

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“…21 In the setting of OLT, the use of MMF seems to allow a reduction in cyclosporine or tacrolimus dose and therefore decreased toxicity. 22 In this report, the use of MMF allowed us to reduce the dose of cyclosporine, even achieving complete withdrawal in most patients. Cyclosporine withdrawal was followed by a moderate but significant improvement in renal function, with a decrease in serum creatinine and urea levels of 0.35 Ϯ 0.14 mg/dL and 0.35 Ϯ 0.04 g/L, respectively, and an increase in creatinine clearance of 8.86 Ϯ 2.08 mL/min.…”

Section: Discussionmentioning

confidence: 85%

Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil

et al. 1999

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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.

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Section: Discussionmentioning

confidence: 85%

Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil

et al. 1999

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“…Eckhoff et al [34] performed a study of liver transplantation, in which there were similar rates of CMV infection among patients receiving tacrolimus versus tacrolimus plus 2g MMF. Lastly, a randomized multicentric trial of 2g MMF versus azathioprine treatment of lung transplant recipients [35] revealed similar rates of CMV infection.…”

Section: Risk Of Cytomegalovirus Infection In Transplant Recipientsmentioning

confidence: 99%

Does mycophenolate mofetil increase the risk of cytomegalovirus infection in solid organ transplant recipients?: A mini-review

Song¹,

Abdala

Bonazzi

et al. 2006

Braz J Infect Dis

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Mycophenolate mofetil (MMF) is currently used for prophylaxis of acute rejection in solid organ transplantation. There have been diverging reports regarding an association between MMF and the risk of cytomegalovirus (CMV) infection. We reviewed the main published studies in an attempt to clarify the association between the use of MMF and the risk, frequency and severity of CMV infections. In a search of the Medline database with the terms "mycophenolate" and "cytomegalovir*", 42 articles were found to be relevant; among these, 29 articles were thoroughly analyzed. The first studies on MMF in renal transplantation already showed a tendency towards an association between this drug and the occurrence of CMV disease. Further studies were designed specifically to study this association; with the conclusion that an immunosuppressive regimen containing MMF increases the likelihood of CMV disease. Most studies were performed with kidney transplant recipients. We conclude that the use of MMF apparently increases the incidence of CMV disease in renal transplant patients; however, further studies are needed to confirm this association.

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“…The success of OLT has improved dramatically over the past few decades [2]. An important aspect of this success is the availability of more potent immunosuppressive drugs.…”

Section: Introductionmentioning

confidence: 99%

Long-term efficacy and safety of mycophenolate mofetil in liver transplant recipients with calcineurin inhibitor-induced renal dysfunction

Koch¹,

Graziadei²,

Schulz³

et al. 2004

Transpl Int

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Long-term survival after orthotopic liver transplantation (OLT) is mainly influenced by adverse events caused by immunosuppression. Several studies have shown the efficacy of mycophenolate mofetil (MMF) in improving calcineurin inhibitor (C1)-induced nephrotoxicity with concomitant reduction or withdrawal of CI. In this prospective study we assessed the long-term effect and safety of MMF. Thirty-two OLT recipients with significant renal impairment due to either cyclosporine A (n = 25) or tacrolimus (n = 7) were enrolled in this study. CIS were reduced stepwise by at least 70%. Mean serum creatinine had decreased from 2.63 f 0.39 to 1.74hO.34 mg/dl after 1 month, and this improvement was maintained within a follow-up period of 4.8 =k 0.6 (range 3.1-6.0) years, without major immunological or nonimmunological side effects. Of all participants, 88% showed a significant reduction, and 41% even a normalization, in their serum creatinine level. In addition, MMF conversion, within 6 months of OLT, appears to be crucial in order to improve or even normalize renal function. This study demonstrates the long-term efficacy and safety of MMF in OLT recipients with CI-induced nephropathy.

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Tacrolimus (Fk506) and Mycophenolate Mofetil Combination Therapy Versus Tacrolimus in Adult Liver Transplantation1

Cited by 103 publications

References 36 publications

Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil

Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil

Does mycophenolate mofetil increase the risk of cytomegalovirus infection in solid organ transplant recipients?: A mini-review

Long-term efficacy and safety of mycophenolate mofetil in liver transplant recipients with calcineurin inhibitor-induced renal dysfunction

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