Four-year follow-up of mycophenolate mofetil for graft rescue in liver allograft recipients.

Background. Mycophenolate mofetil (MMF) has been shown to have promise in s hort-term liver transplantation graft rescue studies. The purpose of this s tudy was to evaluate the long-term efficacy and safety of MMF in liver tran splant patients who had failed cyclosporine (CsA)-based conventional immuno suppression. Methods. Nineteen orthotopic liver allograft recipients were converted from azathioprine to MMF in combination with CsA and prednisone in this prospec tive, open-labeled, single-center, graft rescue, pilot study. Six patients were taken off CsA when MMF was initiated. A 4-year patient follow-up is re ported here. Patients were considered to have failed CsA-based immunosuppre ssion either for refractory rejection, chronic rejection, or severe CsA neu rologic toxicity. Results. Twelve patients had complete histologic resolution, two had partia l resolution, and three had worsening of their rejection. Thirteen patients had a complete biochemical response; one had a partial response and four h ad worsening of their rejection, Two patients had no histologic and one no biochemical follow-up. Of the six patients treated with MMF and prednisone alone, four had complete resolution of rejection without recurrence. The ma jority of adverse reactions were gastrointestinal [nausea and/or vomiting ( n=5); diarrhea (n=8); gastritis, duodenitis, or esophagitis (n=4); and ulce rs (n=2)] or bone marrow suppressive [leukopenia (n=9), anemia (n=6), and t hrombocytopenia (n=5)], Conclusions. MMF seems to be an effective alternative immunosuppressive in patients failing CsA-based conventional therapy. MMF may be of particular b enefit in patients who do not tolerate CsA or tacrolimus. The long-term saf ety profile is similar to that of other immunosuppressives.