Efficacy and Safety of Monotherapy With Mycophenolate Mofetil in Liver Transplantation Patients With Nephrotoxicity.

Abstract

Calcineurin inhibitors (CNI) are the base of immunosuppressive regimens in liver transplantation but they are associated with significant side effects, namely nephrotoxicity, which leads to increased morbidity and mortality. Through time, mycophenolate mofetil (MMF) as monotherapy has been suggested as an alternative in patients with CNI-related toxicity, but still no consensus has been reached as to its efficacy. We have evaluated the safety, efficacy, and tolerability of MMF monotherapy in selected patients, developing CNI-associated events, focusing primarily on kidney dysfunction. Thirty patients were selected (60% men) with a mean age of 48.5 years. Four patients (13%) were initially on a multidrug regimen that included MMF ad initio due to increased risk of kidney dysfunction. CNI tapering was initiated 5.1 years after liver transplantation (5 months to 13.9 years). The mean time of follow-up after conversion to monotherapy with MMF was 5.6 years (14 months to 12 years). Kidney function analysis accessed by creatinine values and glomerular filtration rate measurement showed a gradual improvement (P< .01). Graft dysfunction after conversion to monotherapy was observed in three patients who required reintroduction of the previous immunosuppressive regimen. Four patients referred minor side effects that were managed with dose reduction. None required MMF withdrawal. Ten patients died during follow up, mainly due to disease progression, 6.8 years after MMF conversion. In conclusion, MMF monotherapy seems to be safe, effective, and well tolerated in selected patients.