Real life experience of mycophenolate mofetil monotherapy in liver transplant patients - 16/01/21
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Highlights |
• | Mycophenolate mofetil monotherapy following liver transplantation remains controversial due to a risk of acute rejection. |
• | Therapeutic drug monitoring of mycophenolate acid, the active compound of mycophenolate mofetil, may be a useful tool to limit the risk of rejection as well as the risk of drug toxicity. |
• | The beneficial effect of mycophenolate mofetil monotherapy resulted in a significantly improvement of the glomerular filtration rate one and 5 years after calcineurin inhibitors withdrawal without a high risk of acute rejection. |
Summary |
Background |
Mycophenolate mofetil (MMF) monotherapy following liver transplantation (LT) remains controversial due to a risk of acute rejection. The aim of this study was to report the largest multicenter experience of the use a MMF monotherapy guided by therapeutic drug monitoring using pharmacoslope modeling and Bayesian estimations of the MPA inter-dose AUC (BEAUCMPA) before withdrawing calcineurin inhibitors (CNI) and to evaluate the benefit of MMF monotherapy.
Methods |
MMF daily doses were adjusted to reach the BEAUCMPA target of 45μg.h/mL. Then CNI were withdrawn and patients were followed on liver test and clinical outcomes.
Main findings |
From 2000-2014, in 2 transplantation centers, 94 liver transplant recipients received MMF monotherapy 6.5±4 years after LT. The mean BEAUCMPA was 45.5±16μg.h/mL. During follow-up, 4 patients experienced acute rejection (4%). During the first year, estimated glomerular filtration rate (eGFR) improved from 46.2±10.5 to 49.1±11.5mL/kg/min (P=0.025). Benefit persisted at year 5. In patients with metabolic syndrome, eGFR did not improve.
Conclusion |
MMF monotherapy regimen appears usually safe and beneficial, with low risk of acute rejection and eGFR improvement. Therapeutic drug monitoring strategy seemed useful by identifying 14% of patients with low MMF exposure.
Le texte complet de cet article est disponible en PDF.Keywords : Liver transplantation, Acute rejection, Mycophenolate mofetil, Chronic kidney dysfunction
Abbreviations : CKD, CNI, TDM, GFR, LT, MMF, MPA
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Vol 45 - N° 1
Article 101451- janvier 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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