Manzia T M, De Liguori Carino N, Orlando G, Toti L, De Luca L, D'Andria D, Cardillo A, Anselmo A, Casciani C U, Tisone G
Liver Transplant Unit, Surgical Clinic, Tor Vergata University of Rome S. Eugenio Hospital Rome, Italy.
Transplant Proc. 2005 Jul-Aug;37(6):2616-7. doi: 10.1016/j.transproceed.2005.06.073.
Mycophenolate mofetil (MMF) is an immunosuppressive drug, exhibiting its effect through inhibition of proliferation of T and B lymphocytes. Standard primary immunosuppressive therapy after orthotopic liver transplantation (OLT) is based on a calcineurin-inhibitor (CNI): cyclosporine or tacrolimus. Renal failure with arterial hypertension, due to CNI side-effects, is a major cause of morbidity and mortality after OLT. Several studies have shown the efficacy of MMF to improve CNI-induced nephrotoxicity, blood pressure, and uric acid concentration in liver transplant patients with concomitant reduction or withdrawal of CNI. Predose plasma mycophenolic acid concentrations (MPA) are related to adverse events, drug dose, and clinical status. Blood level values outside the suggested MPA therapeutic range are associated with acute rejection episodes and side effects, which have been described in about half of the patients treated with MMF. Most authors have described gastrointestinal and hematological side-effects, whereas these appear usually dose related, responding quickly to reduction. MMF is potent and safe immunosuppressive agent, and replacement of CNI by MMF in liver transplant patients with renal dysfunction may improve not only kidney function but also other CNI-associated side-effects, such as hypertension and hyperuricemia, with a low risk of rejection.
霉酚酸酯（MMF）是一种免疫抑制剂，通过抑制T和B淋巴细胞的增殖发挥作用。原位肝移植（OLT）后的标准初始免疫抑制治疗基于钙调神经磷酸酶抑制剂（CNI）：环孢素或他克莫司。由于CNI的副作用导致的伴有动脉高血压的肾衰竭是OLT后发病和死亡的主要原因。多项研究表明，在肝移植患者中，MMF在减少或停用CNI的同时，能有效改善CNI诱导的肾毒性、血压和尿酸浓度。霉酚酸（MPA）给药前的血浆浓度与不良事件、药物剂量和临床状态有关。MPA治疗范围之外的血药浓度值与急性排斥反应和副作用相关，在接受MMF治疗的患者中约有一半出现过此类情况。大多数作者描述过胃肠道和血液学方面的副作用，而这些副作用通常与剂量相关，减少剂量后反应迅速。MMF是一种强效且安全的免疫抑制剂，在肾功能不全的肝移植患者中用MMF替代CNI不仅可以改善肾功能，还可以改善其他与CNI相关的副作用，如高血压和高尿酸血症，且排斥反应风险较低。
