Pierini A, Mirabella S, Brunati A, Ricchiuti A, Franchello A, Salizzoni M
Liver Transplantation Centre, Molinette Hospital, Turin, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2614-5. doi: 10.1016/j.transproceed.2005.06.005.
Calcineurin inhibitors (CI) are associated with significant morbidity in transplant recipients. The aim of this study was to evaluate the effectiveness and safety of mycophenolate mofetil (MMF) monotherapy in liver transplantation (LT).
We analysed 32 patients (24 males, 8 female, of mean age 55.7 years) who underwent LT between 1994 and 2003. In 29 patients immunosuppressive therapy was cyclosporine; in three patients it was tacrolimus. Eleven patients were submitted for LT due to hepatitis B cirrhosis; eight for hepatitis C cirrhosis, six for alcoholic cirrhosis, and seven for other diseases. In these patients, MMF was added gradually, simultaneously reducing the dosage of CI up to complete withdrawal. We considered the efficacy (decrease in serum creatinine) and the incidence of complications (acute and chronic rejection, leukopenia, diarrhea).
Patients were converted to MMF after a median of 50 months after LT. MMF monotherapy was started after a median of 9 months in association with CI. Indications for switch to MMF monotherapy were adverse effects of CI (renal disfunction in 30 patients) and de novo tumoral evidence after LT in two patients. Median dosage of MMF was 750 mg twice daily (500-1500 mg). There was a statistically significant decrease in serum creatinine levels (2.02-1.7 mg/dL; P = .0001). Side effects were: leukopenia in five of 32 patients (15.6%), diarrhea in four of 32 patients (12.5%), and one acute rejection.
MMF monotherapy improved renal function and was not associated with a significant risk of allograft rejection. Side effects were mild with dose regimens up to 750 mg twice daily.
钙调神经磷酸酶抑制剂（CI）与移植受者的显著发病率相关。本研究的目的是评估霉酚酸酯（MMF）单药疗法在肝移植（LT）中的有效性和安全性。
我们分析了1994年至2003年间接受LT的32例患者（24例男性，8例女性，平均年龄55.7岁）。29例患者的免疫抑制治疗采用环孢素；3例患者采用他克莫司。11例患者因乙型肝炎肝硬化接受LT；8例因丙型肝炎肝硬化，6例因酒精性肝硬化，7例因其他疾病。在这些患者中，逐渐添加MMF，同时降低CI的剂量直至完全停用。我们考虑了疗效（血清肌酐降低）和并发症发生率（急性和慢性排斥反应、白细胞减少、腹泻）。
患者在LT后中位50个月转换为MMF。与CI联合使用中位9个月后开始MMF单药治疗。转换为MMF单药治疗的指征是CI的不良反应（30例患者出现肾功能障碍）和2例患者LT后出现新发肿瘤证据。MMF的中位剂量为每日两次750mg（500 - 1500mg）。血清肌酐水平有统计学显著下降（从2.02mg/dL降至1.7mg/dL；P = 0.0001）。副作用包括：32例患者中有5例出现白细胞减少（15.6%），32例患者中有4例出现腹泻（12.5%），以及1例急性排斥反应。
MMF单药疗法改善了肾功能，且与同种异体移植排斥反应的显著风险无关。每日两次剂量高达750mg的治疗方案副作用较轻。
