Abstract
Liver transplant recipients are at high risk to develop acute and chronic renal failure. Sparing calcineurin inhibitors (CNI) with the use of mycophenolate mofetil (MMF) may improve renal function without increasing the risk of acute rejection, graft loss, or death. We therefore conducted a systematic review and meta-analysis of randomized, controlled trials. Eight trials could be identified according to predefined selection criteria: two trials in which MMF was used directly after liver transplantation in combination with reduced dose CNI compared to normal dose CNI without MMF; and six trials in which patients were converted to MMF in combination with reduction or elimination of CNI. In conversion trials estimated glomerular filtration rate was higher in patients that received MMF in combination with low-dose CNI compared to patients that continued CNI (mean difference 8.27, 95%-confidence interval [CI] 3.65 to 12.90), but patients in the experimental group also had a significantly higher risk of acute rejection (risk ratio [RR] 4.96, CI 1.75 to 14.07). In de-novo trials the risks of acute rejection, graft loss, and death were not statistically different, but patients had a lower risk of post-operative renal dysfunction (RR 0.57, CI 0.41 to 0.78).
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