Usefulness of mycophenolate mofetil in patients with chronic renal insufficiency after liver transplantation

Abstract

NEPHROTOXICITY is a common side effect after liver transplantation (LT). Chronic renal insufficiency (CRI) appears in 50% to 79% of patients during long-term follow-up. The incidence of end-stage renal disease (ESRD) ranges between 2% and 9.5%. The use of calcineurin inhibitors (CNI) is the main cause of CRI after LT. Although acute renal failure related to CNI responds to dosage adjustment, the management of patients with CRI is difficult because cyclosporine or tacrolimus dose reduction generally does not improve renal function and withdrawal can be associated with graft rejection. In contrast to CNI, the newer immunosuppressive agents, mycophenolate mofetil (MMF) and sirolimus, are not nephrotoxic. Therefore, trials have been designed to withdraw CNI with the use of these new immunosuppressive agents in patients with chronic renal insufficiency. MMF is an inhibitor of inosine monophosphate dehydrogenase, which inhibits proliferation of T and B lymphocytes. The aim of our study was to evaluate the evolution of the renal function in patients with chronic renal dysfunction after liver transplantation with the use of mycophenolate mofetil, associated with a slow tapering and withdrawal of CNI.