MYCOPHENOLATE MOFETIL ALLOWS OVERALL REDUCTION OF IMMUNOSUPPRESSION IN LIVER TRANSPLANTS WITHOUT ADVERSE EFFECTS

Abstract

241 Despite proven effectiveness in reducing acute rejection in liver transplant (OLT) recipients, tacrolimus (Prograf®, TAC) and prednisone (PRED) still present significant side effects. The addition of mycophenolate (Cellcept®, MMF) may allow for lower doses of TAC and PRED, especially during the early post-transplant period. The purpose of this study is to evaluate the impact on overall reduction of immunosuppressive medications via addition of MMF to the TAC/PRED regimen without compromising the allograft function. 35 liver recipients on TAC regimen were given MMF immediately post-op. Mean age of transplant recipients was 49.3 years (ranges 25-65 years). 1 year patient survival was 91.2% (32/35). 19/35 (54.3%) of the patients were HCV positive. All received 1 gram methylprednisolone intra-op with rapid taper (PRED 100 mg on POD 1, 20 mg on POD 5). Immunosuppression was as follows: (Table) 17/35 (48.6%) of patients had evidence of renal insufficiency (RI) with creatinine clearance (Cr Cl) of <60 cc/min for at least 1 month prior to transplantation. TAC immunosuppression initiation was lowered in these patients. Mean changes in Cr Cl following OLT for the RI patients were +45.1%, +36.7%, and +67.9% at 1, 6, and 12 months post-op as compared to −25.4%, −17.4%, and −7.6% for normal renal function patients. The incidence of rejection episodes was 41.2% (7/17) in RI patients as compared to 27.8% (5/18) for the other group (p=0.32). HCV recurrence diagnosis was made via biochemical, HCV-RNA and liver biopsy studies. HCV recurred in 10 out of 19 (52.6%), mostly during the first 3 months (median: 2 months, range 1-12). The rate of wound infection was 2.9% (1/35). 22.9% (8/35) of patients had side-effects directly attributable to MMF (diarrhea, abdominal cramping, nausea, vomiting, neutropenia). Complete steroid withdrawal at 3 and 12 months post-op were 12% (3/25) and 90.9% (10/11), respectively. In summary, addition of MMF to TAC/PRED regimen allowed overall reduction of TAC/PRED doses. This prevented further renal function deterioration without an increased incidence of rejection or HCV recurrence.Table