The renal benefit of mycophenolate mofetil after liver transplantation

Haywood, Samuel; Abécassis, Michaël; Levitsky, Josh

doi:10.1111/j.1399-0012.2010.01339.x

“…In this study, age, diabetes, dyslipidemia, and creatinine were independently associated with long-term MACEs after LDLT, which is consistent with the findings of previous studies [ 4 , 37 ]. Our study showed that a CACS of >400 combined with obstructive CAD might be superior to conventional coronary risk factors in terms of predicting long-term MACEs.…”

Section: Discussionsupporting

confidence: 93%

Prognostic Value of Computed Tomographic Coronary Angiography for Long-Term Major Adverse Cardiac Events after Liver Transplantation

Kim

¹

,

Kim

²

,

Ha

³

et al. 2021

JCM

3

0

View full text Add to dashboard Cite

Computed tomographic coronary angiography (CTCA) has prognostic value for early major adverse cardiac events (MACEs) after liver transplantation. However, the association between CTCA and long-term MACEs in liver transplant (LT) recipients remains unknown. We evaluated the association between CTCA and long-term MACEs within 5 years after living donor liver transplantation (LDLT). A total of 628 LDLT recipients who underwent CTCA were analyzed between 2010 and 2012. MACEs were investigated within 5 years after LDLT. The factors associated with long-term MACEs in transplant recipients were evaluated. Only 48 (7.6%) patients developed MACEs. In the Fine and Gray competing risk regression, a coronary artery calcium score (CACS) of >400 combined with obstructive coronary artery disease (CAD) (subdistribution hazard ratio: 5.01, 95% confidence interval: 2.37–10.58, p < 0.001), age (1.05, 1.01–1.10, p = 0.018), diabetes mellitus (2.43, 1.37–4.29, p = 0.002), dyslipidemia (2.45, 1.23–4.70, p = 0.023), and creatinine (1.19, 1.08–1.30, p < 0.001) were independently associated with long-term MACEs. CACS (>400) combined with obstructive CAD may be associated with MACEs within 5 years after LDLT, suggesting the importance of preoperative noninvasive CTCA in LT recipients. The evaluation of coronary artery stenosis on CTCA combined with CACS may have a prognostic value for long-term MACEs in LT recipients.

show abstract

“…The recognition of these facts induced interest in preventing CNI toxicity. It has also reported that the use of adjunctive MMF immediately after LT might protect against CNI nephrotoxicity, potentially without the need for dose reduction or increased risk of adverse events [25]. Therefore, current strategies to overcome CNI toxicity include reduction or withdrawal of CNIs along with switching to mTOR inhibitor or MMF-based regimens [11,12,14,15,[26][27][28].…”

Section: Discussionmentioning

confidence: 99%

Evidence for the Immunosuppressive Potential of Calcineurin Inhibitor-Sparing Regimens in Liver Transplant Recipients with Impaired Renal Function

Tanimine

¹

,

Ide

²

,

Tanaka

³

et al. 2012

Transplantation Journal

0

View full text Add to dashboard Cite

Patients requiring liver transplantation (LT) frequently experience renal insufficiency (RI), which affects their survival. Although calcineurin inhibitor-sparing immunosuppressive regimens (CSRs) are well known to prevent RI, the immune state in recipients receiving CSR remains to be intensively investigated. Among 60 cases of living-donor LT at our institute, 68% of the patients had none to mild RI (non-RI group) and 32% of the patients had moderate to severe RI (RI group). The RI group received a CSR comprising reduced dose of tacrolimus, methylprednisolone, and mycophenolate mofetil, while the non-RI group received a regimen comprising conventional dose of tacrolimus and methylprednisolone. One year after LT, the mean estimated glomerular filtration rate (eGFR) in the RI group had significantly improved, although it was still lower than that of the non-RI group. Serial mixed lymphocyte reaction assays revealed that antidonor T-cell responses were adequately suppressed in both groups. Thus, we provide evidence that CSR leads to improvement of eGFR after LT in patients with RI, while maintaining an appropriate immunosuppressive state.

show abstract

“…The recognition of these facts induced interest in preventing CNI toxicity. It has also reported that the use of adjunctive MMF immediately after LT might protect against CNI nephrotoxicity, potentially without the need for dose reduction or increased risk of adverse events [25]. Therefore, current strategies to overcome CNI toxicity include reduction or withdrawal of CNIs along with switching to mTOR inhibitor or MMF-based regimens [11, 12, 14, 15, 26–28].…”

Section: Discussionmentioning

confidence: 99%

Evidence for the Immunosuppressive Potential of Calcineurin Inhibitor-Sparing Regimens in Liver Transplant Recipients with Impaired Renal Function

Ide

¹

,

Tanaka

²

,

Onoe

³

et al. 2011

Journal of Transplantation

View full text Add to dashboard Cite

Patients requiring liver transplantation (LT) frequently experience renal insufficiency (RI), which affects their survival. Although calcineurin inhibitor-sparing immunosuppressive regimens (CSRs) are well known to prevent RI, the immune state in recipients receiving CSR remains to be intensively investigated. Among 60 cases of living-donor LT at our institute, 68% of the patients had none to mild RI (non-RI group) and 32% of the patients had moderate to severe RI (RI group). The RI group received a CSR comprising reduced dose of tacrolimus, methylprednisolone, and mycophenolate mofetil, while the non-RI group received a regimen comprising conventional dose of tacrolimus and methylprednisolone. One year after LT, the mean estimated glomerular filtration rate (eGFR) in the RI group had significantly improved, although it was still lower than that of the non-RI group. Serial mixed lymphocyte reaction assays revealed that antidonor T-cell responses were adequately suppressed in both groups. Thus, we provide evidence that CSR leads to improvement of eGFR after LT in patients with RI, while maintaining an appropriate immunosuppressive state.

show abstract

The renal benefit of mycophenolate mofetil after liver transplantation

Abstract: The use of adjunctive MMF immediately after LT may protect against calcineurin inhibitor nephrotoxicity, potentially without the need for dose reduction or increased risk of adverse events.

Cited by 12 publications

References 40 publications

Prognostic Value of Computed Tomographic Coronary Angiography for Long-Term Major Adverse Cardiac Events after Liver Transplantation

Prognostic Value of Computed Tomographic Coronary Angiography for Long-Term Major Adverse Cardiac Events after Liver Transplantation

Evidence for the Immunosuppressive Potential of Calcineurin Inhibitor-Sparing Regimens in Liver Transplant Recipients with Impaired Renal Function

Evidence for the Immunosuppressive Potential of Calcineurin Inhibitor-Sparing Regimens in Liver Transplant Recipients with Impaired Renal Function

Contact Info

Product

Resources

About