Purpose: To evaluate the use of mycophenolate mofetil (MMF) and its effects on renal outcomes in liver transplant recipients

Methods: Adult liver transplant recipients from September 1, 2012 to September 30, 2015 at a single center were identified retrospectively and categorized based upon the immunosuppression regimen received. Patients were separated into two groups based upon whether or not they received at least one dose of MMF in addition to a calcineurin inhibitor and corticosteroid during their first year post-transplant (MMF group and no-MMF group). Patients were excluded from analysis if they were less than 19 years of age, received induction with antithymocyte globulin, or deceased within 6 months post-transplant. The primary outcome was change in renal function at 6 months from baseline. Secondary outcomes included change in renal function at 12 months, biopsy-proven rejection, infectious complications, leukopenia, and thrombocytopenia. Descriptive statistics were used for demographic data. Chi-square and Fisher's exact test were used for categorical variables and Wilcoxon rank sum test for continuous variables.

Results: Of 255 adult liver transplant recipients, 146 patients were included in the analysis. Of the 146 patients, twelve did not receive MMF during the first year post-transplant. Average change in glomerular filtration rate (GFR) (mL/min/1.73m²) at 6 months was -21.4 in the no-MMF group vs. -12 in the MMF group (p=0.15). Average change in GFR (mL/min/1.73m²) at 12 months was -21.2 in control group vs. -11.1 in MMF group (p=0.20). Increased incidence of all secondary outcomes were observed in the MMF group. However, study groups were not balanced with substantially more patients in the MMF group. Patients in the MMF group appeared to have a trend toward less renal dysfunction. The majority of patients who received at least one dose of MMF had stopped MMF by 6 months post-transplant. Those who remained on MMF appeared to have sustained renal dysfunction, suggesting MMF was being used to prevent further renal injury.

Conclusions: These findings suggest that the addition of MMF to a calcineurin inhibitor and coriticosteroid within one-year post-transplant may lead to less renal dysfunction in liver transplant recipients. It is unknown whether sustaining MMF for the full year provides additional benefit. Study of optimal duration and timing of MMF should continue to be evaluated.

CITATION INFORMATION: Henry M., Vacha M. Effects of the Addition of Mycophenolate Mofetil on Renal Outcomes in Liver Transplant Recipients: A Single Center Review Am J Transplant. 2017;17 (suppl 3).

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