The association between MMF and risk of progressive renal dysfunction and death in adult liver transplant recipients with HCV

• Published in: Clinical transplantation Vol. 23; no. 1; pp. 108 - 115
• Main Authors: Lake, John, Patel, Dharmesh, David, Kristin, Richwine, Jason, Morris, Jonathan
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-01-2009; Wiley
• Subjects: Acute Disease; Adolescent; Adult; Aged; Biological and medical sciences; chronic kidney disease; Cohort Studies; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Glomerular Filtration Rate; Graft Rejection - etiology; Graft Survival - drug effects; hepatitis C; Hepatitis C - surgery; Hepatitis C virus; Human viral diseases; Humans; immunosuppression; Immunosuppressive Agents - therapeutic use; Infectious diseases; Liver Transplantation; Liver, biliary tract, pancreas, portal circulation, spleen; Male; Medical sciences; Middle Aged; mycophenolate mofetil; Mycophenolic Acid - analogs & derivatives; Mycophenolic Acid - therapeutic use; Renal Insufficiency - etiology; Renal Insufficiency - mortality; Renal Insufficiency - prevention & control; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Tissue, organ and graft immunology; Viral diseases; Viral hepatitis; Young Adult; Mofetil; Mycophenolic acid; Liver; Hepatic disease; Risk; Homotransplantation; Kidney; Association; Surgery; Adult; Antiviral; Graft; Viral hepatitis C; Human; Kidney disease; Urinary system disease; Digestive system; Enzyme; Mortality; IMP dehydrogenase; Enzyme inhibitor; Chronic kidney disease; chronic kidney disease-hepatitis C; Infection; Virus; Immunomodulator; Medicine; Progressive; Antibiotic; Immunosuppression; Treatment; Urinary system; Dysfunction; Viral disease; Renal failure; Risk factor; Digestive diseases; Death; Oxidoreductases; Immunosuppressive agent; Mycophenolate mofetil; Flaviviridae; Inosine monophosphate dehydrogenase inhibitor; Hepatitis C virus; Hepacivirus; Liver transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2008.00916.x

The impact of a three‐drug regimen including mycophenolate mofetil (MMF) vs. a two‐drug (no MMF) regimen on progressive renal dysfunction (PRD) in liver transplant recipients with hepatitis C virus (HCV) infection has not been well described. Adults with HCV who received a primary liver transplant between January 1, 2000 and December. 31, 2005 and were discharged from the hospital on a three‐drug regimen [CNI+MMF+steroids (S)] (n = 4 946) were compared with those discharged on two‐drug regimen (CNI+S) (n = 3 884). Time to PRD (defined by a post‐transplant 25% decline in estimated GFR, based on the four‐variable MDRD equation) and recipient death were evaluated using Kaplan–Meier analysis. Cox proportional hazards regression was used to estimate the risk for post‐transplant PRD and death after controlling for baseline characteristics and extended steroid use. The two groups were similar in baseline characteristics. The percentage of recipients on three‐ vs. two‐drug regimen without PRD was higher, 36.8% vs. 31.9%, (p < 0.001), at three yrs post‐transplant; three‐drug therapy was associated with a 6% lower adjusted risk of PRD. The death rate and adjusted risk for death was lower for recipients on a three‐ vs. two‐drug regimen. Liver transplant recipients with HCV on a MMF‐containing regimen are at a lower risk for PRD and death compared with recipients on a regimen not including MMF.