Jiménez-Pérez M, Lozano Rey J M, Marín García D, Olmedo Martín R, de la Cruz Lombardo J, Rodrigo López J M
Hepatology-Liver Transplant Unit, Hospital Universitario Carlos Haya, Malaga, Spain.
Transplant Proc. 2006 Oct;38(8):2480-1. doi: 10.1016/j.transproceed.2006.08.039.
To analyze the efficacy and safety of mycophenolate mofetil (MMF) as monotherapy in liver transplant patients who have adverse effects associated with calcineurin inhibitors (CNIs).
Seventeen patients, 13 men and four women, mean age 62 years, who received a liver transplant between 1998 and 2003 and initial immunosuppressive therapy with CNIs (10 tacrolimus and seven cyclosporine), were converted to monotherapy with MMF due to adverse events associated with CNIs: chronic renal failure in 16 patients (four with diabetes mellitus and seven with hypertension) and neurotoxicity in one patient. The mean time between transplant and starting monotherapy was 32 months (range: 18 to 70) and the mean follow-up time on monotherapy was 20 months (range: 8 to 39). MMF was introduced gradually at the same time as the CNIs were reduced.
There was a progressive decrease in creatinine during the initial months. Compared with baseline levels, the differences at 3 and 6 months of monotherapy were significant (P < .001), remaining so throughout the follow-up period. Renal function improved in 15 of 17 patients (88%) and normalized in 10 of 17 (60%). The patient with neurotoxicity due to CNI improved. One patient (6%) had moderate rejection that was corrected after reintroducing tacrolimus. In two patients it was necessary to suspend MMF, one due to gastrointestinal intolerance and the other due to severe myelotoxicity and Pneumocystis jiroveci infection. Other, minor adverse events were corrected by adjusting the dose: one herpes zoster, two diarrhea, and two anemia.
Monotherapy with MMF efficiently and safely corrected renal dysfunction associated with CNIs, with few side effects and a low incidence of rejection.
分析霉酚酸酯（MMF）单药治疗对与钙调神经磷酸酶抑制剂（CNIs）相关不良反应的肝移植患者的疗效及安全性。
17例患者，13例男性，4例女性，平均年龄62岁，于1998年至2003年接受肝移植，并初始采用CNIs进行免疫抑制治疗（10例使用他克莫司，7例使用环孢素），因与CNIs相关的不良事件转为MMF单药治疗：16例患者出现慢性肾衰竭（4例合并糖尿病，7例合并高血压），1例患者出现神经毒性。移植与开始单药治疗的平均时间为32个月（范围：18至70个月），单药治疗的平均随访时间为20个月（范围：8至39个月）。在减少CNIs的同时逐渐引入MMF。
最初几个月肌酐水平逐渐下降。与基线水平相比，单药治疗3个月和6个月时的差异有统计学意义（P <.001），在整个随访期间均保持如此。17例患者中有15例（88%）肾功能改善，17例中有10例（60%）恢复正常。因CNI导致神经毒性的患者病情改善。1例患者（6%）发生中度排斥反应，重新引入他克莫司后得到纠正。2例患者需要停用MMF，1例因胃肠道不耐受，另1例因严重骨髓毒性和耶氏肺孢子菌感染。其他轻微不良事件通过调整剂量得到纠正：1例带状疱疹、2例腹泻和2例贫血。
MMF单药治疗有效且安全地纠正了与CNIs相关的肾功能障碍，副作用少，排斥反应发生率低。
