Improvement of Renal Function After Conversion to Mycophenolate Mofetil Combined With Low-Level Calcineurin Inhibitor in Liver Transplant Recipients With Chronic Renal Dysfunction
Abstract Introduction Calcineurin inhibitors (CNI) are the main pathogenic factors for renal dysfunction in solid organ transplant recipients. Introduction of non-nephrotoxic immunosuppressive drugs, such as mycophenolate mofetil (MMF), may allow discontinuation or reduction of CNI treatment, thereb...
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| Veröffentlicht in: | Transplantation proceedings 2010-03, Vol.42 (2), p.656-659 |
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| description | Abstract Introduction Calcineurin inhibitors (CNI) are the main pathogenic factors for renal dysfunction in solid organ transplant recipients. Introduction of non-nephrotoxic immunosuppressive drugs, such as mycophenolate mofetil (MMF), may allow discontinuation or reduction of CNI treatment, thereby improving renal function. The aim of this study was to assess the feasibility, efficacy and safety of MMF introduction and CNI dosage reduction in the maintenance immunosuppressive protocol to improve renal function in liver transplant recipients with chronic renal dysfunction. Patients and Methods We prospectively included 88 liver transplant recipients including 74 men and an overall mean age of 58.8 ± 10.3 years who all displayed chronic renal dysfunction (creatinine >1.4 mg/dL) and proteinuria 2 mg/dL (group III; n = 19). MMF was initiated at 1.5–2.0 g/d. Reduction of tacrolimus or cyclosporine dosage was performed to achieve respective target trough levels of |
| doi_str_mv | 10.1016/j.transproceed.2010.02.006 |
| format | Article |
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Introduction of non-nephrotoxic immunosuppressive drugs, such as mycophenolate mofetil (MMF), may allow discontinuation or reduction of CNI treatment, thereby improving renal function. The aim of this study was to assess the feasibility, efficacy and safety of MMF introduction and CNI dosage reduction in the maintenance immunosuppressive protocol to improve renal function in liver transplant recipients with chronic renal dysfunction. Patients and Methods We prospectively included 88 liver transplant recipients including 74 men and an overall mean age of 58.8 ± 10.3 years who all displayed chronic renal dysfunction (creatinine >1.4 mg/dL) and proteinuria <1 g/d. They were subdivided into 3 groups according to the basal creatinine value 1.4–1.7 mg/dL (group I; n = 41); 1.8–2.0 mg/dL (group II; n = 28); and >2 mg/dL (group III; n = 19). MMF was initiated at 1.5–2.0 g/d. Reduction of tacrolimus or cyclosporine dosage was performed to achieve respective target trough levels of <5 ng/mL or <50 ng/mL. We performed periodic determinations of arterial pressure, liver function tests, serum creatinine, blood cells count, CNI levels, and proteinuria. Results Creatinine values after conversion were 1.4 ± 0.5 mg/dL in the overall group. Improvement of renal function was more frequent among groups I (80.4%) and II (92.8%) versus III (73.6%). Normalization of creatinine values was more frequent in group I (68.2%) with respect to cohorts II (21.4%) and III (10.5%). Rejection was not detected. Conclusion Application of an immunosuppressive protocol with MMF and low-level CNI in liver transplant recipients with chronic renal dysfunction was associated with improvement or normalization of creatinine, without an increased risk of rejection. Early conversion is needed to achieve the best results.</description><identifier>ISSN: 0041-1345</identifier><identifier>EISSN: 1873-2623</identifier><identifier>DOI: 10.1016/j.transproceed.2010.02.006</identifier><identifier>PMID: 20304216</identifier><identifier>CODEN: TRPPA8</identifier><language>eng</language><publisher>Amsterdam: Elsevier Inc</publisher><subject>Adolescent ; Aged ; Alanine Transaminase - blood ; Aspartate Aminotransferases - blood ; Bilirubin - blood ; Biological and medical sciences ; Creatinine - blood ; Cyclosporine - therapeutic use ; Drug Therapy, Combination ; Fundamental and applied biological sciences. Psychology ; Fundamental immunology ; Humans ; Immunosuppressive Agents - therapeutic use ; Kidney - drug effects ; Kidney - physiology ; Kidney - physiopathology ; Kidney Function Tests ; Liver Transplantation - immunology ; Male ; Medical sciences ; Middle Aged ; Mycophenolic Acid - analogs & derivatives ; Mycophenolic Acid - therapeutic use ; Nephrology. Urinary tract diseases ; Nephropathies. Renovascular diseases. Renal failure ; Prothrombin Time ; Renal failure ; Surgery ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Tissue, organ and graft immunology</subject><ispartof>Transplantation proceedings, 2010-03, Vol.42 (2), p.656-659</ispartof><rights>Elsevier Inc.</rights><rights>2010 Elsevier Inc.</rights><rights>2015 INIST-CNRS</rights><rights>Copyright (c) 2010 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-80f9be9b9231877a851a30b8fd095e835c61aeaac03cb77af38d79d6b488158b3</citedby><cites>FETCH-LOGICAL-c464t-80f9be9b9231877a851a30b8fd095e835c61aeaac03cb77af38d79d6b488158b3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.transproceed.2010.02.006$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>310,311,315,781,785,790,791,3551,23935,23936,25145,27929,27930,46000</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22744890$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20304216$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ponton, C</creatorcontrib><creatorcontrib>Vizcaíno, L</creatorcontrib><creatorcontrib>Tomé, S</creatorcontrib><creatorcontrib>Otero, E</creatorcontrib><creatorcontrib>Molina, E</creatorcontrib><creatorcontrib>Castroagudín, J.F</creatorcontrib><creatorcontrib>López-Lago, A</creatorcontrib><creatorcontrib>Varo Pérez, E</creatorcontrib><title>Improvement of Renal Function After Conversion to Mycophenolate Mofetil Combined With Low-Level Calcineurin Inhibitor in Liver Transplant Recipients With Chronic Renal Dysfunction</title><title>Transplantation proceedings</title><addtitle>Transplant Proc</addtitle><description>Abstract Introduction Calcineurin inhibitors (CNI) are the main pathogenic factors for renal dysfunction in solid organ transplant recipients. Introduction of non-nephrotoxic immunosuppressive drugs, such as mycophenolate mofetil (MMF), may allow discontinuation or reduction of CNI treatment, thereby improving renal function. The aim of this study was to assess the feasibility, efficacy and safety of MMF introduction and CNI dosage reduction in the maintenance immunosuppressive protocol to improve renal function in liver transplant recipients with chronic renal dysfunction. Patients and Methods We prospectively included 88 liver transplant recipients including 74 men and an overall mean age of 58.8 ± 10.3 years who all displayed chronic renal dysfunction (creatinine >1.4 mg/dL) and proteinuria <1 g/d. They were subdivided into 3 groups according to the basal creatinine value 1.4–1.7 mg/dL (group I; n = 41); 1.8–2.0 mg/dL (group II; n = 28); and >2 mg/dL (group III; n = 19). MMF was initiated at 1.5–2.0 g/d. Reduction of tacrolimus or cyclosporine dosage was performed to achieve respective target trough levels of <5 ng/mL or <50 ng/mL. We performed periodic determinations of arterial pressure, liver function tests, serum creatinine, blood cells count, CNI levels, and proteinuria. Results Creatinine values after conversion were 1.4 ± 0.5 mg/dL in the overall group. Improvement of renal function was more frequent among groups I (80.4%) and II (92.8%) versus III (73.6%). Normalization of creatinine values was more frequent in group I (68.2%) with respect to cohorts II (21.4%) and III (10.5%). Rejection was not detected. Conclusion Application of an immunosuppressive protocol with MMF and low-level CNI in liver transplant recipients with chronic renal dysfunction was associated with improvement or normalization of creatinine, without an increased risk of rejection. Early conversion is needed to achieve the best results.</description><subject>Adolescent</subject><subject>Aged</subject><subject>Alanine Transaminase - blood</subject><subject>Aspartate Aminotransferases - blood</subject><subject>Bilirubin - blood</subject><subject>Biological and medical sciences</subject><subject>Creatinine - blood</subject><subject>Cyclosporine - therapeutic use</subject><subject>Drug Therapy, Combination</subject><subject>Fundamental and applied biological sciences. Psychology</subject><subject>Fundamental immunology</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney - drug effects</subject><subject>Kidney - physiology</subject><subject>Kidney - physiopathology</subject><subject>Kidney Function Tests</subject><subject>Liver Transplantation - immunology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mycophenolic Acid - analogs & derivatives</subject><subject>Mycophenolic Acid - therapeutic use</subject><subject>Nephrology. Urinary tract diseases</subject><subject>Nephropathies. Renovascular diseases. Renal failure</subject><subject>Prothrombin Time</subject><subject>Renal failure</subject><subject>Surgery</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Tissue, organ and graft immunology</subject><issn>0041-1345</issn><issn>1873-2623</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNUl2P0zAQjBCI6x38BWQhIZ5S7DgfDg9Ipx4HlXpCOg7Bm-U4G9UlsYvtFPV33R9kQ3MC8cRT4t3Z8Xhmk-Qlo0tGWflmt4xe2bD3TgO0y4xig2ZLSstHyYKJiqdZmfHHyYLSnKWM58VZch7CjuI5y_nT5CyjHH9ZuUju1wPyHGAAG4nryC1Y1ZPr0eponCWXXQRPVs4ewIepEB25OWq334J1vYpAblwH0fSIGRpjoSVfTdySjfuZbuAAWFe9xvrojSVruzWNic4TPGwMcpK73y_pFd5-C9rsDeoIJ47V1jtr9Czp6hi6WdWz5Emn-gDP5-9F8uX6_d3qY7r59GG9utykOi_zmAra1Q3UTZ1xNKVSomCK00Z0La0LELzQJVOglKZcN9jvuGirui2bXAhWiIZfJK9PvOjQjxFClIMJGnpUC24MsuJcULSbIvLtCam9C8FDJ_feDMofJaNyykzu5N-ZySkzSTOJmeHwi_masRmw9zD6EBICXs0AFbTqOyTSJvzBZVWei3pScXXCAZpyMOBl0OinhtZ40FG2zvyfnnf_0OjeYBCq_w5HCDs3egwkSCYDDsjP05ZNS8Zwv1guvvFfU3_U6Q</recordid><startdate>20100301</startdate><enddate>20100301</enddate><creator>Ponton, C</creator><creator>Vizcaíno, L</creator><creator>Tomé, S</creator><creator>Otero, E</creator><creator>Molina, E</creator><creator>Castroagudín, J.F</creator><creator>López-Lago, A</creator><creator>Varo Pérez, E</creator><general>Elsevier Inc</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20100301</creationdate><title>Improvement of Renal Function After Conversion to Mycophenolate Mofetil Combined With Low-Level Calcineurin Inhibitor in Liver Transplant Recipients With Chronic Renal Dysfunction</title><author>Ponton, C ; Vizcaíno, L ; Tomé, S ; Otero, E ; Molina, E ; Castroagudín, J.F ; López-Lago, A ; Varo Pérez, E</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-80f9be9b9231877a851a30b8fd095e835c61aeaac03cb77af38d79d6b488158b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Adolescent</topic><topic>Aged</topic><topic>Alanine Transaminase - blood</topic><topic>Aspartate Aminotransferases - blood</topic><topic>Bilirubin - blood</topic><topic>Biological and medical sciences</topic><topic>Creatinine - blood</topic><topic>Cyclosporine - therapeutic use</topic><topic>Drug Therapy, Combination</topic><topic>Fundamental and applied biological sciences. Psychology</topic><topic>Fundamental immunology</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney - drug effects</topic><topic>Kidney - physiology</topic><topic>Kidney - physiopathology</topic><topic>Kidney Function Tests</topic><topic>Liver Transplantation - immunology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mycophenolic Acid - analogs & derivatives</topic><topic>Mycophenolic Acid - therapeutic use</topic><topic>Nephrology. Urinary tract diseases</topic><topic>Nephropathies. Renovascular diseases. Renal failure</topic><topic>Prothrombin Time</topic><topic>Renal failure</topic><topic>Surgery</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Tissue, organ and graft immunology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ponton, C</creatorcontrib><creatorcontrib>Vizcaíno, L</creatorcontrib><creatorcontrib>Tomé, S</creatorcontrib><creatorcontrib>Otero, E</creatorcontrib><creatorcontrib>Molina, E</creatorcontrib><creatorcontrib>Castroagudín, J.F</creatorcontrib><creatorcontrib>López-Lago, A</creatorcontrib><creatorcontrib>Varo Pérez, E</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Transplantation proceedings</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ponton, C</au><au>Vizcaíno, L</au><au>Tomé, S</au><au>Otero, E</au><au>Molina, E</au><au>Castroagudín, J.F</au><au>López-Lago, A</au><au>Varo Pérez, E</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improvement of Renal Function After Conversion to Mycophenolate Mofetil Combined With Low-Level Calcineurin Inhibitor in Liver Transplant Recipients With Chronic Renal Dysfunction</atitle><jtitle>Transplantation proceedings</jtitle><addtitle>Transplant Proc</addtitle><date>2010-03-01</date><risdate>2010</risdate><volume>42</volume><issue>2</issue><spage>656</spage><epage>659</epage><pages>656-659</pages><issn>0041-1345</issn><eissn>1873-2623</eissn><coden>TRPPA8</coden><abstract>Abstract Introduction Calcineurin inhibitors (CNI) are the main pathogenic factors for renal dysfunction in solid organ transplant recipients. Introduction of non-nephrotoxic immunosuppressive drugs, such as mycophenolate mofetil (MMF), may allow discontinuation or reduction of CNI treatment, thereby improving renal function. The aim of this study was to assess the feasibility, efficacy and safety of MMF introduction and CNI dosage reduction in the maintenance immunosuppressive protocol to improve renal function in liver transplant recipients with chronic renal dysfunction. Patients and Methods We prospectively included 88 liver transplant recipients including 74 men and an overall mean age of 58.8 ± 10.3 years who all displayed chronic renal dysfunction (creatinine >1.4 mg/dL) and proteinuria <1 g/d. They were subdivided into 3 groups according to the basal creatinine value 1.4–1.7 mg/dL (group I; n = 41); 1.8–2.0 mg/dL (group II; n = 28); and >2 mg/dL (group III; n = 19). MMF was initiated at 1.5–2.0 g/d. Reduction of tacrolimus or cyclosporine dosage was performed to achieve respective target trough levels of <5 ng/mL or <50 ng/mL. We performed periodic determinations of arterial pressure, liver function tests, serum creatinine, blood cells count, CNI levels, and proteinuria. Results Creatinine values after conversion were 1.4 ± 0.5 mg/dL in the overall group. Improvement of renal function was more frequent among groups I (80.4%) and II (92.8%) versus III (73.6%). Normalization of creatinine values was more frequent in group I (68.2%) with respect to cohorts II (21.4%) and III (10.5%). Rejection was not detected. Conclusion Application of an immunosuppressive protocol with MMF and low-level CNI in liver transplant recipients with chronic renal dysfunction was associated with improvement or normalization of creatinine, without an increased risk of rejection. Early conversion is needed to achieve the best results.</abstract><cop>Amsterdam</cop><pub>Elsevier Inc</pub><pmid>20304216</pmid><doi>10.1016/j.transproceed.2010.02.006</doi><tpages>4</tpages></addata></record> |
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| subjects | Adolescent Aged Alanine Transaminase - blood Aspartate Aminotransferases - blood Bilirubin - blood Biological and medical sciences Creatinine - blood Cyclosporine - therapeutic use Drug Therapy, Combination Fundamental and applied biological sciences. Psychology Fundamental immunology Humans Immunosuppressive Agents - therapeutic use Kidney - drug effects Kidney - physiology Kidney - physiopathology Kidney Function Tests Liver Transplantation - immunology Male Medical sciences Middle Aged Mycophenolic Acid - analogs & derivatives Mycophenolic Acid - therapeutic use Nephrology. Urinary tract diseases Nephropathies. Renovascular diseases. Renal failure Prothrombin Time Renal failure Surgery Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Tissue, organ and graft immunology |
| title | Improvement of Renal Function After Conversion to Mycophenolate Mofetil Combined With Low-Level Calcineurin Inhibitor in Liver Transplant Recipients With Chronic Renal Dysfunction |
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