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MYCOPHENOLATE MONOTHERAPY IN CYCLOSPORINE-INDUCED NEPHROPATHY AFTER LIVER TRANSPLANTATION - PRELIMINARY RESULTS

1999; Wolters Kluwer; Volume: 67; Issue: 7 Linguagem: Inglês

10.1097/00007890-199904150-00791

1534-6080

S. Adler, Ewert Schulte‐Frohlinde, Robert Brauer, J. D. Roder, CD Heidecke,

Organ Transplantation Techniques and Outcomes

767 INTRODUCTION: Cyclosporine-induced nephropathy is a problem in about 4% of patients after successful liver transplantation (LTX). The addition of non-nephrotoxic immunosuppressants such as mycophenolate-mofetil (MMF) led to improved transplant function at decreased cyclosporine (CsA) levels. The aim of this pilot-trial was a CsA-free immunosuppression with MMF-monotherapy postulating an improvement in renal function. PATIENTS AND METHODS: 6 out of 41 patients, having undergone liver transplantion within the past two years, demonstrated CsA-induced nephropathy. 6 liver transplant patients (age 57 ± 11 years) with stable liver function at > 6 months after LTX and de novo nephropathy under immunosuppression with CsA were converted to MMF-monotherapy. Recent liver histology excluded acute rejection. Duration of conversion was 3 months with simultaneously increasing MMF-dosage (250mg bid to a maximum of 2g bid) and reduction of CsA leading to a complete conversion. Dose adjustments were performed every 2 to 3 weeks after clinical monitoring. Follow-up ranged between 2 and 8 months. RESULTS: Four patients were successfully converted to MMF-monotherapy with improvement of renal function. Serum-creatinine fell from an average of 2.6 mg/dl to 1.4 mg/dl. One patient was reswitched to CsA with suspicion of Cytomegalovirus-infection. One patient suffered end-stage renal failure due to a preexisting glomerulonephritis but is still on MMF-monotherapy without signs of rejection. None of the patients experienced acute rejection or severe infection. Liver function remained stable in all 6 patients. CONCLUSION: 6 out of 41 liver transplant patients suffered CsA-induced nephropathy. 4 out of 6 patients were successfully converted to MMF-monotherapy with reduction of serum-creatinine. Complete conversion from CsA-baseline immunosuppression to MMF-monotherapy can be a safe option for a selected group of liver transplant patients with CsA-nephrotoxicity.