Manrique A, Jiménez C, Ortega P, Abradelo M, Gimeno A, Calvo J, Cambra F, -Sterup R L, Morales J M, Moreno E
Alejandro Manrique Municio, Hospital Doce de Octubre, Servicio de Cirugía General, Madrid, Spain.
Transplant Proc. 2008 Nov;40(9):2962-4. doi: 10.1016/j.transproceed.2008.09.040.
Mycophenolate mofetil (MMF) monotherapy has recently been proposed for liver transplant recipients with adverse events (nephrotoxicity, hypertension) related to calcineurin inhibitors. We analyzed the influence of MMF on the clinical course of recurrent hepatitis C.
Among 1038 patients who underwent liver transplantation (OLT) from April 1986 to October 2006, we analyzed 48 adult recipients (4.6%) whose diagnosis was hepatitis C virus (HCV) cirrhosis and who were converted from calcineurin inhibitors to MMF monotherapy.
The 36 men and 12 women, had a mean age at OLT of 52.9 +/- 7.2 years; the time elapsed from OLT to the onset of MMF monotherapy was 72.5 +/- 47.6 months (range = 11-210). The mean follow-up after monotherapy was 19 +/- 16.1 months (range = 2-67). Indications for conversion were: chronic renal dysfunction with HCV in 45 patients; HCV recurrence in two; and hypertension plus HCV recurrence in one subject. When the indication was renal dysfunction (excluding three patients who underwent hemodialysis), the mean creatinine values decreased significantly from baseline to 6 months of monotherapy from 1.63 +/- 0.61 mg/dL to 1.51 +/- 0.78 mg/dL (P < .03). The creatinine clearance only improved significantly from the baseline value of 56.6 +/- 16.8 mL/min to the value at 3 months of monotherapy-63.6 +/- 18.4 mL/min (P < .001). At the last outpatient visit, creatinine and creatinine clearances had not changed significantly. The mean diastolic blood pressure did improve significantly at the end of the study. The mean glucose levels decreased but not significantly at the last outpatient visit. Liver function tests did not change significantly after conversion to MMF monotherapy. The acute rejection rate was 8.3%, and adverse events related to MMF monotherapy were present in 9 patients (18.7%).
Conversion from calcineurin inhibitors to MMF monotherapy in patients who underwent OLT for HCV transiently improved renal function and hypertension. The acute rejection rate was low, and adverse events were usually well tolerated.
霉酚酸酯（MMF）单药治疗最近被推荐用于肝移植受者，这些受者出现了与钙调神经磷酸酶抑制剂相关的不良事件（肾毒性、高血压）。我们分析了MMF对丙型肝炎复发临床病程的影响。
在1986年4月至2006年10月接受肝移植（OLT）的1038例患者中，我们分析了48例成年受者（4.6%），他们被诊断为丙型肝炎病毒（HCV）肝硬化，并且从钙调神经磷酸酶抑制剂转换为MMF单药治疗。
36名男性和12名女性，OLT时的平均年龄为52.9±7.2岁；从OLT到开始MMF单药治疗的时间为72.5±47.6个月（范围=11-210个月）。单药治疗后的平均随访时间为19±16.1个月（范围=2-67个月）。转换的指征为：45例患者合并HCV的慢性肾功能不全；2例患者HCV复发；1例患者高血压合并HCV复发。当指征为肾功能不全时（不包括3例接受血液透析的患者），从基线到单药治疗6个月时，平均肌酐值从1.63±0.61mg/dL显著降至1.51±0.78mg/dL（P<.03）。肌酐清除率仅从基线值56.6±16.8mL/min显著提高到单药治疗3个月时的值63.6±18.4mL/min（P<.001）。在最后一次门诊就诊时，肌酐和肌酐清除率没有显著变化。研究结束时平均舒张压确实显著改善。最后一次门诊就诊时平均血糖水平下降但不显著。转换为MMF单药治疗后肝功能检查没有显著变化。急性排斥反应率为8.3%，9例患者（18.7%）出现了与MMF单药治疗相关的不良事件。
对于因HCV接受OLT的患者，从钙调神经磷酸酶抑制剂转换为MMF单药治疗可短暂改善肾功能和高血压。急性排斥反应率较低，不良事件通常耐受性良好。
