Barrera Pulido L, Alamo Martínez J M, Pareja Ciuró F, Gómez Bravo M A, Serrano Díez-Canedo J, Bernal Bellido C, Suárez Artacho G, García González I, Pascasio Acevedo J M, Bernardos Rodríguez A
Hepatobiliopancreatic Surgery and Liver Transplant Unit, Virgen del Rocio University Hospitals, Seville, Spain.
Transplant Proc. 2008 Nov;40(9):2985-7. doi: 10.1016/j.transproceed.2008.09.017.
To assess the efficacy and safety of mycophenolate mofetil (MMF) monotherapy in liver transplant recipients with renal failure secondary to the use of calcineurin inhibitors (CNIs).
Thirty-one patients on MMF monotherapy with creatinine levels >1.3 mg/dL, previously immunosuppressed with CNIs and MMF, were analyzed. Conversion was started in patients with no acute or chronic rejection episodes and stable liver chemistry. CNI doses were reduced by 25% every 2 to 3 months, or to 50% if the dose was lower than 1 mg/d of tacrolimus or 50 mg/d of cyclosporine. Different variables were recorded from the time that conversion to monotherapy was decided, on the discontinuation day of the calcineurin inhibitor, and during the follow-up.
Mean times from transplant to conversion ranged from 14 to 186 months. The minimum follow-up time in monotherapy was 12 months. Renal function improved at 6 months in 70% of cases and at 12 months in 69.6%. Patients with no renal function improvement maintained stable creatinine values. There were no rejection episodes, graft losses, or deaths. No leukopenia occurred, and triglyceride and uric acid values improved.
MMF monotherapy is a safe alternative in patients with posttransplant renal failure secondary to the use of CNIs. Renal function improvement was achieved in almost 70% of patients at 12 months, and creatinine values were maintained in all other patients. The risk of rejection due to the slow tapering of CNIs is minimum.
评估霉酚酸酯（MMF）单药治疗因使用钙调神经磷酸酶抑制剂（CNI）继发肾衰竭的肝移植受者的疗效和安全性。
分析31例接受MMF单药治疗、肌酐水平>1.3mg/dL、既往接受CNI和MMF免疫抑制的患者。在无急性或慢性排斥反应发作且肝功能稳定的患者中开始转换治疗。每2至3个月将CNI剂量降低25%，如果他克莫司剂量低于1mg/d或环孢素剂量低于50mg/d，则降至50%。从决定转换为单药治疗时、钙调神经磷酸酶抑制剂停用日以及随访期间记录不同变量。
从移植到转换的平均时间为14至186个月。单药治疗的最短随访时间为12个月。70%的病例在6个月时肾功能改善，69.6%在12个月时改善。肾功能未改善的患者肌酐值保持稳定。无排斥反应发作、移植物丢失或死亡。未发生白细胞减少，甘油三酯和尿酸值改善。
MMF单药治疗是因使用CNI继发移植后肾衰竭患者的一种安全替代方案。近70%的患者在12个月时肾功能得到改善，所有其他患者肌酐值保持稳定。因CNI逐渐减量导致排斥反应的风险最小。
