The renal benefit of mycophenolate mofetil after liver transplantation

Abstract

The risk and benefit of adding mycophenolate mofetil (MMF) to a standard immunosuppressive regimen at the time of liver transplantation (LT) is not well described. We performed a retrospective case-control analysis comparing one-yr outcomes of all LT recipients at our institution treated with post-operative tacrolimus (TAC), MMF, and steroids vs. TAC and steroids. A total of 101 LT recipients (50:51 case:control) were analyzed. Despite more renal dysfunction at LT, the MMF + TAC group had similar serum creatinine (Cr) and glomerular filtration rate (GFR) as the TAC group one-yr post-LT. In this time period, Cr decreased (1.57-1.22 mg/dL, p = 0.04) and GFR increased (57.5-65.1 mL/min per 1.73 m(2), p = 0.05) in the MMF + TAC group, while Cr increased (1.11-1.35, p < 0.01) and GFR declined (73.5-60.1, p < 0.001) in the TAC group. These findings occurred without a difference in absolute rejection episodes, hospitalizations, infections, deaths, or time to above events (p > 0.05). Subgroup analysis of patients stratified by pre-transplant renal dysfunction (Cr ≥ 1.2 mg/dL) supported the previous. MMF was reasonably well tolerated with a low rate of discontinuation. 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.