Conversion to Mycophenolate Mofetil Monotherapy in Liver Recipients: Calcineurin Inhibitor Levels are Key

• Published in: Annals of hepatology Vol. 16; no. 1; pp. 94 - 106
• Main Authors: Norero, Blanca, Serrano, Carolina A, Sanchez-Fueyo, Alberto, Duarte, Ignacio, Torres, Javiera, Ocquetau, Mauricio, Barrera, Francisco, Arrese, Marco, Soza, Alejandro, Benítez, Carlos
• Format: Journal Article
• Language: English
• Published: Mexico Asociación Mexicana de Hepatología, A.C 01-01-2017; Elsevier
• Subjects: Aged; Calcineurin inhibitors; Calcineurin Inhibitors - administration & dosage; Calcineurin Inhibitors - adverse effects; Chi-Square Distribution; Conversion; Cyclosporine - administration & dosage; Cyclosporine - adverse effects; Drug Administration Schedule; Drug Monitoring - methods; Drug Therapy, Combination; Forkhead Transcription Factors - immunology; Gastroenterology & Hepatology; Gastroenterology and Hepatology; Graft Rejection - immunology; Graft Rejection - prevention & control; Graft Survival - drug effects; Humans; Immunosuppressive Agents - administration & dosage; Immunosuppressive Agents - adverse effects; Kidney - drug effects; Kidney - physiopathology; Liver transplantation; Liver Transplantation - adverse effects; Male; Middle Aged; Minimization; Multivariate Analysis; Mycophenolate mofetil; Mycophenolic Acid - administration & dosage; Mycophenolic Acid - adverse effects; Odds Ratio; Prospective Studies; Renal function; Risk Factors; T-Lymphocytes - immunology; Tacrolimus - administration & dosage; Tacrolimus - adverse effects; Time Factors; Treatment Outcome; Minimization; Renal function; Mycophenolate mofetil; Conversion; Calcineurin inhibitors; Liver transplantation
• ISSN: 1665-2681
• DOI: 10.5604/16652681.1226820

AbstractThe use of calcineurin inhibitors (CNI) after liver transplantation is associated with post-transplant nephrotoxicity. Conversion to myc-ophenolate mofetil (MMF) monotherapy improves renal function, but is related to graft rejection in some recipients. Our aim was to identify variables associated with rejection after conversion to MMF monotherapy. Conversion was attempted in 40 liver transplant recipients. Clinical variables were determined and peripheral mononuclear blood cells were immunophenotyped during a 12-month follow-up. Conversion was classified as successful (SC) if rejection did not occur during the follow-up. MMF conversion was successful with 28 patients (70%) and was associated with higher glomerular filtration rates at the end of study. It also correlated with increased time elapsed since transplantation, low baseline CNI levels (Tacrolimus ≤ 6.5 ng/mL or Cyclosporine ≤ 635 ng/mL) and lower frequency of tacrolimus use. The only clinical variable independently related to SC in multivariate analysis was low baseline CNI levels (p = 0.02, OR: 6.93, 95%, CI: 1.3-29.7). Mean baseline fluorescent intensity of FOXP3+ T cells was significantly higher among recipients with SC. In conclusion, this study suggests that baseline CNI levels can be used to identify recipients with higher probability of SC to MMF monotherapy. Clinicaltrials.gov identification: NCT01321112.