Although mycophenolate mofetil (MMF) monotherapy has been successfully used in liver transplant recipients suffering from calcineurin-inhibitor (CNI)-related chronic toxicity, still no consensus has been reached on its safety, efficacy and tolerability. We attempted the complete weaning off CNI in 42 individuals presenting chronic renal dysfunction and/or dyslipidemia and/or arterial hypertension and simultaneously introduced 1.5 gm/day MMF. CNI could be completely withdrawn in 41 cases. A total of 32 (75%) patients are currently on <= 1.5 gm/day of MMF. Mean follow-up from the introduction of MMF is 31.5 months and mean length of follow-up from the beginning of MMF monotherapy is 27.3 months. Renal function improved in 31/36 (89%) cases. Blood levels of cholesterol and triglycerides decreased in 13 of 17 (76%) and 15 of 17 (89%) patients, respectively. Arterial hypertension improved in 4 of 5 (80%) cases. A total of 8 patients showed a single episode of fluctuation of liver function tests during tapering off CNI. This feature was interpreted as an acute rejection (AR), based on the resolution of the clinical setting after escalation of MMF daily dose to 2 gm. A further patient developed a biopsy-proven AR insensitive to MMF adjustment, requiring reinstitution of the CNI dose. No deaths or major toxicity requiring MMF discontinuation occurred. In conclusion, low dose MMF monotherapy is safe, effective, and well tolerated.

Orlando, G., Baiocchi, L., Cardillo, A., Iaria, G., De Liguori, N., De Luca, L., et al. (2007). Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension. LIVER TRANSPLANTATION, 13(1), 46-54 [10.1002/lt.20926].

Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension

BAIOCCHI, LEONARDO;ANGELICO, MARIO;TISONE, GIUSEPPE
2007

Abstract

Although mycophenolate mofetil (MMF) monotherapy has been successfully used in liver transplant recipients suffering from calcineurin-inhibitor (CNI)-related chronic toxicity, still no consensus has been reached on its safety, efficacy and tolerability. We attempted the complete weaning off CNI in 42 individuals presenting chronic renal dysfunction and/or dyslipidemia and/or arterial hypertension and simultaneously introduced 1.5 gm/day MMF. CNI could be completely withdrawn in 41 cases. A total of 32 (75%) patients are currently on <= 1.5 gm/day of MMF. Mean follow-up from the introduction of MMF is 31.5 months and mean length of follow-up from the beginning of MMF monotherapy is 27.3 months. Renal function improved in 31/36 (89%) cases. Blood levels of cholesterol and triglycerides decreased in 13 of 17 (76%) and 15 of 17 (89%) patients, respectively. Arterial hypertension improved in 4 of 5 (80%) cases. A total of 8 patients showed a single episode of fluctuation of liver function tests during tapering off CNI. This feature was interpreted as an acute rejection (AR), based on the resolution of the clinical setting after escalation of MMF daily dose to 2 gm. A further patient developed a biopsy-proven AR insensitive to MMF adjustment, requiring reinstitution of the CNI dose. No deaths or major toxicity requiring MMF discontinuation occurred. In conclusion, low dose MMF monotherapy is safe, effective, and well tolerated.
Pubblicato
Rilevanza internazionale
Articolo
Sì, ma tipo non specificato
Settore MED/12 - Gastroenterologia
Settore MED/18 - Chirurgia Generale
English
Con Impact Factor ISI
antiemetic agent; antivirus agent; calcineurin inhibitor; cholesterol; cyclosporin A; mycophenolic acid 2 morpholinoethyl ester; rapamycin; tacrolimus; triacylglycerol; acute graft rejection; adult; aged; article; asthenia; cholesterol blood level; clinical trial; controlled clinical trial; controlled study; drug blood level; drug dose escalation; drug dose increase; drug dose reduction; drug efficacy; drug fatality; drug safety; drug substitution; drug tolerability; drug withdrawal; dyslipidemia; female; follow up; herpes zoster; human; human tissue; hypertension; kidney dysfunction; leukopenia; liver biopsy; liver function test; liver transplantation; low drug dose; male; monotherapy; nausea and vomiting; priority journal; skin infection; thrombocytopenia; triacylglycerol blood level; Adult; Aged; Calcineurin; Cholesterol; Dyslipidemias; Female; Humans; Hypertension; Immunosuppressive Agents; Kidney; Liver Transplantation; Male; Middle Aged; Mycophenolic Acid; Prospective Studies; Time Factors; Triglycerides
Orlando, G., Baiocchi, L., Cardillo, A., Iaria, G., De Liguori, N., De Luca, L., et al. (2007). Switch to 1.5 grams MMF monotherapy for CNI-related toxicity in liver transplantation is safe and improves renal function, dyslipidemia, and hypertension. LIVER TRANSPLANTATION, 13(1), 46-54 [10.1002/lt.20926].
Orlando, G; Baiocchi, L; Cardillo, A; Iaria, G; De Liguori, N; De Luca, L; Ielpo, B; Tariciotti, L; Angelico, M; Tisone, G
Articolo su rivista
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/2108/57939
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