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Jiménez-Romero C, Justo Alonso I, Caso Maestro O, Manrique Municio A, García-Sesma Á, Calvo Pulido J, Cambra Molero F, Loinaz Segurola C, Martín-Arriscado C, Nutu A, Marcacuzco Quinto A. Indications and Long-Term Outcomes of Using Mycophenolate Mofetil Monotherapy in Substitution for Calcineurin Inhibitors in Liver Transplantation. Transpl Int 2025; 38:13790. [PMID: 40060933 PMCID: PMC11886422 DOI: 10.3389/ti.2025.13790] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2024] [Accepted: 01/27/2025] [Indexed: 05/13/2025]
Abstract
Switching the use of calcineurin inhibitors (CNIs), as basal immunosuppression in liver transplantation (LT) patients, for that of mycophenolate mofetil monotherapy (MMF-MT) is currently considered a good measure in recipients with chronic kidney disease (CKD) and other CNI-related adverse effects. We analyzed a retrospective cohort series of 324 LT patients who underwent long-term follow-up and were switched from CNI immunosuppression to MMF-MT due to CKD and other CNI-related adverse effects (diabetes, hypertension, infection). The median time on MMF-MT was 78 months. The indication for MMF-MT was CKD alone or associated with CNI-related adverse effects in 215 patients, diabetes in 61, hypertension in 42, and recurrent cholangitis in 6. Twenty-four (7.4%) patients developed non-resistant acute rejection post-MMF-MT, and 48 (14.8%) patients experienced MMF-related adverse effects, with MMF-MT withdrawn in only 8 (2.5%) patients. In the comparison between the pre-MMF-MT period and the last outpatient review, using a repeated measures model and taking each patient as its own comparator, we demonstrated a significant increase in GFR and significant decrease in creatinine and ALT values, remaining the other variables (diabetes, hypertension, and hematological and AST) within similar levels. Five-year survival post-MMF-MT conversion was 75.3%. MMF-MT significantly improved renal function, was well tolerated, and had a low rejection rate.
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Affiliation(s)
- Carlos Jiménez-Romero
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Iago Justo Alonso
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Oscar Caso Maestro
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alejandro Manrique Municio
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Álvaro García-Sesma
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Jorge Calvo Pulido
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Félix Cambra Molero
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Carmelo Loinaz Segurola
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | | | - Anisa Nutu
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Alberto Marcacuzco Quinto
- Unit of Hepato-Pancreato-Biliary Surgery and Abdominal Organ Transplantation, Doce de Octubre University Hospital, Madrid, Spain
- Department of Surgery, Faculty of Medicine, Complutense University, Madrid, Spain
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De Simone P, Bronzoni J, Martinelli C. Everolimus versus mycophenolate mofetil in liver transplantation: every improvement in renal function matters. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:312-313. [PMID: 35545915 DOI: 10.17235/reed.2022.8902/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2025]
Abstract
The current edition of the journal features a Spanish, nationwide, multi-institutional study by Gomez Bravo MA et al. exploring the advantages of everolimus (EVR)-facilitated tacrolimus (TAC) minimization versus TAC in combination with mycophenolate mofetil (MMF) after liver transplantation (LT).
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Affiliation(s)
- Paolo De Simone
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Italia
| | - Jessica Bronzoni
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Italia
| | - Caterina Martinelli
- Hepatobiliary Surgery and Liver Transplantation, University of Pisa Medical School Hospital, Italia
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Gastaca M, Prieto M, Palomares I, Bustamante J, Fernandez JR, Ruiz P, Ventoso A, Salvador P, Senosiain M, Testillano M, Suarez MJ, Valdivieso A. Long-Term Outcomes of Liver Transplantation in Patients With Pretransplant Renal Dysfunction Treated With Induction Therapy and Delayed Reduced De Novo Once-Daily Tacrolimus. Transplant Proc 2020; 52:1489-1492. [PMID: 32217015 DOI: 10.1016/j.transproceed.2020.01.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/02/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Renal dysfunction is related to short- and long-term survival after liver transplantation. We present herein a retrospective analysis of our experience with liver transplantation in recipients with pretransplant renal dysfunction treated with induction therapy followed by delayed/reduced de novo once-daily tacrolimus. METHODS Liver transplantations performed between April 2008 and August 2011 were included in this study. Pretransplant renal dysfunction was defined as estimated glomerular filtration rate <60 mL/min. Interleukin-2 receptor antagonists were used for induction therapy. Initial once-daily tacrolimus dose was 0.10 mg/kg/day or 0.07 mg/kg/day if combined with mycophenolate mofetil (MMF). Tacrolimus target trough levels were 4 to 6 ng/mL during the first post-transplant year and <4 ng/mL the rest of the follow-up. RESULTS Nineteen patients comprised the study cohort with a median follow-up of 56.4 months (range, 11-78). Median day of tacrolimus introduction was 7 (range, 3-12). Once-daily tacrolimus was withdrawn in 6 patients (31.6%) due to evolution of renal dysfunction in all cases. At 5 years, 30% of the patients were under MMF monotherapy. Mean tacrolimus trough levels were maintained under 5 ng/mL. Mean estimated glomerular filtration rate at 5 years was 55.3 ± 12.7 mL/min. No patient needed hemodialysis or renal transplantation over the follow-up. Patient survival at 5 years was 78.9%. CONCLUSIONS Induction therapy followed by delayed/reduced de novo once-daily tacrolimus and maintenance of low tacrolimus exposition during the follow-up is effective to maintain long-term renal function and to achieve favorable patient survival in liver transplant recipients with pretransplant renal dysfunction.
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Affiliation(s)
- Mikel Gastaca
- Biocruces Bizkaia Health Research Institute, Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain; Medicine Department, University of the Basque Country, Bilbao, Spain.
| | - Mikel Prieto
- Biocruces Bizkaia Health Research Institute, Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain; Medicine Department, University of the Basque Country, Bilbao, Spain
| | - Ibone Palomares
- Biocruces Bizkaia Health Research Institute, Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Javier Bustamante
- Biocruces Bizkaia Health Research Institute, Hepatology Unit, Hospital Universitario Cruces, Bilbao, Spain; Medicine Department, University of the Basque Country, Bilbao, Spain
| | - José R Fernandez
- Biocruces Bizkaia Health Research Institute, Hepatology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Patricia Ruiz
- Biocruces Bizkaia Health Research Institute, Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Alberto Ventoso
- Biocruces Bizkaia Health Research Institute, Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Patricia Salvador
- Biocruces Bizkaia Health Research Institute, Hepatology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Maria Senosiain
- Biocruces Bizkaia Health Research Institute, Hepatology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Milagros Testillano
- Biocruces Bizkaia Health Research Institute, Hepatology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Maria J Suarez
- Biocruces Bizkaia Health Research Institute, Hepatology Unit, Hospital Universitario Cruces, Bilbao, Spain
| | - Andrés Valdivieso
- Biocruces Bizkaia Health Research Institute, Hepatobiliary Surgery and Liver Transplantation Unit, Hospital Universitario Cruces, Bilbao, Spain; Medicine Department, University of the Basque Country, Bilbao, Spain
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