Schmeding Maximilian, Neumann Ulf P, Neuhaus Ruth, Neuhaus Peter
Department of General and Transplantation Surgery, Charité Campus Virchow Klinikum, Berlin, Germany.
Clin Transplant. 2006;20 Suppl 17:75-9. doi: 10.1111/j.1399-0012.2006.00604.x.
Liver transplantation (LTX) today has become a routine procedure granting curative treatment for various hepatic diseases with excellent survival rates. Constant improvement of immuno-suppressive regimens has led to significant reduction of rejection frequency and increased safety in long-term management. Calcineurin-inhibitors play the key role in most immunosuppressive protocols providing strong T-cell suppression yet often associated with numerous side-effects. Increasing renal insufficiency as well as hypertension, hyperglycaemia, hyperuricaemia, and increased risk of secondary malignancy account for the major problems in short- and long-term follow-up of LTX patients. Mycophenolate mofetil (MMF) as a purine-synthesis inhibitor has proved to be a potent immunosuppressive agent largely free of the CI-associated side-effects. MMF therefore has been used to modulate immunosuppressive protocols in order to both increase efficacy and to reduce CI-related side-effects such as nephrotoxicity. In recent years, MMF-monotherapy protocols have been suggested for LTX patients with renal insufficiency. This review provides an overview on the current role of MMF in immunosuppressive protocols after LTX and evaluates innovative therapeutic concepts.
如今，肝移植（LTX）已成为一种常规手术，可为各种肝脏疾病提供治愈性治疗，患者生存率极高。免疫抑制方案的不断改进显著降低了排斥反应的发生率，并提高了长期管理的安全性。钙调神经磷酸酶抑制剂在大多数免疫抑制方案中起着关键作用，它能强效抑制T细胞，但往往伴有许多副作用。肾功能不全以及高血压、高血糖、高尿酸血症和继发性恶性肿瘤风险增加是肝移植患者短期和长期随访中的主要问题。霉酚酸酯（MMF）作为一种嘌呤合成抑制剂，已被证明是一种有效的免疫抑制剂，基本没有与钙调神经磷酸酶抑制剂相关的副作用。因此，MMF已被用于调整免疫抑制方案，以提高疗效并减少与钙调神经磷酸酶抑制剂相关的副作用，如肾毒性。近年来，有人建议对肾功能不全的肝移植患者采用MMF单一疗法方案。本综述概述了MMF在肝移植后免疫抑制方案中的当前作用，并评估了创新的治疗理念。
