Improvement of acute and chronic renal dysfunction in liver transplant patients after substitution of calcineurin inhibitors by mycophenolate mofetil

Background Renal dysfunction caused by treatment with the calcineurin inhib itors (CNI) is a major problem in the long-term course after liver transpla ntation, Patients, In 22 liver graft recipients with renal dysfunction and stable gr aft function between 3 weeks and 12 years after transplantation, CNI were s ubstituted by MMF at a final dose of 1.5-3 g/day between October 1996 and O ctober 1998. Methods, In a prospective non-randomized study, the development of renal fu nction, the side effects of MMF medication, and the stability of liver func tion were analyzed for a mean follow-up of 15 months. Results. (1) MMF was withdrawn in four patients for major side effects between 1 and 7 months af ter study entry; eight patients had minor side effects. (2) Six months afte r study entry, renal function had improved in 17 of the 22 study patients; mean serum creatinine +/-SD (mu mol/L) was 201 +/- 77 at entry and 153 +/- 65 after 3 months (P < 0,001). (3) Improvement occurred in 11 of 15 patient s with creatinine elevation greater than or equal to 12 months and in 6 of 6 patients with creatinine elevation less than or equal to 6 months, (4) On e patient developed transient liver dysfunction and a second required retra nsplantation for progressive cholestasis but without signs of rejection. Conclusions, In patients who undergo liver transplantation, substitution of CNI by MMF leads to improvement of acute as well as chronic renal dysfunct ion in most cases. Side effects of MMF may be limiting in some patients, an d the immunological consequences remain to be studied.