MMF and Calcineurin Taper in Recurrent Hepatitis C After Liver Transplantation: Impact on Histological Course

Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is almost universal. The optimal immunosuppression for these patients is still under discussion. We designed a retrospective case‐control study to evaluate the effect of mycophenolate mofetil (MMF) treatment in patients...

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Published in:	American journal of transplantation Vol. 5; no. 2; pp. 406 - 411
Main Authors:	Bahra, Marcus, Neumann, UIF P., Jacob, Dietmar, Puhl, Gero, Klupp, Jochen, Langrehr, Jan M., Berg, Thomas, Neuhaus, Peter
Format:	Journal Article
Language:	English
Published:	Oxford, UK Munksgaard International Publishers 01-02-2005 Blackwell
Subjects:	Biological and medical sciences Calcineurin Inhibitors Case-Control Studies Female Graft Rejection - drug therapy Hepacivirus - genetics Hepatitis C Hepatitis C - drug therapy Human viral diseases Humans Immunosuppressive Agents - pharmacology Infectious diseases Liver Transplantation Male Medical sciences MMF Mycophenolic Acid - analogs & derivatives Mycophenolic Acid - pharmacology Retrospective Studies RNA, Viral - metabolism Tacrolimus - pharmacology Time Factors Viral diseases Viral diseases of the digestive system Viral hepatitis Mofetil Relapse Mycophenolic acid Prognosis Calcineurin inhibitor Calcineurin Hepatic disease Case control study Homotransplantation Orthotopic transplantation Viral load Viral hepatitis C Human Drug combination Enzyme Transferases MMF Increase Histology Inflammation Recurrent Retrospective Infection Virus Case study Immunosuppression Score Treatment Decrease Biopsy Follow up study Viral disease Fibrosis Digestive diseases Immunosuppressive agent Mycophenolate mofetil Flaviviridae Severe Hepatitis C virus Hepatitis C Hepacivirus Discussion Comparative study liver transplantation
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Summary:	Hepatitis C virus (HCV) recurrence after orthotopic liver transplantation (OLT) is almost universal. The optimal immunosuppression for these patients is still under discussion. We designed a retrospective case‐control study to evaluate the effect of mycophenolate mofetil (MMF) treatment in patients with recurrent hepatitis C. Forty patients with histologically proven hepatitis C recurrence after OLT were treated with MMF and calcineurin inhibitor (CNI) taper for 24 months and matched with 40 non‐MMF‐treated positive liver transplant recipients. Liver biopsies were obtained prior to MMF treatment and after a mean follow‐up of 24 months. Histological changes were evaluated utilizing the Metavir score. Comparison of fibrosis/inflammation showed no impairment of histological findings during MMF treatment. In contrast, histological findings of the 40 non‐MMF patients showed a significant increase of severity for inflammation/fibrosis. Viral load was similar in both groups. The course of alanin amino transferase (ALT) levels measured during MMF treatment showed a significant decrease. MMF in combination with CNI taper showed a positive effect on fibrosis progression, graft inflammation and ALT levels and may improve the clinical course of HCV after OLT, however, the antiviral properties of MMF are still unconfirmed.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1600-6135 1600-6143
DOI:	10.1111/j.1600-6143.2004.00706.x