Mycophenolate mofetil added to immunosuppression after liver transplantation - first results

Klupp, J; Bechstein, Wolf O.; Platz, K.-P.; Keck, H.; Lemmens, H. P.; Knoop, M.; Langrehr, Jan M.; Neuhaus, R.; Pratschke, Johann

doi:10.1007/s001470050046

Cited by 22 publications

(17 citation statements)

References 11 publications

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“…An open prospective study of 20 liver transplant recipients has shown that MMF appears to be a safe and potentially useful adjuvant immunosuppressive agent for rescue and maintenance therapy that will not increase the risk for neurotoxicity. 24 Our study has several limitations. First, cases may not be representative of all liver transplant recipients with mental status changes of otherwise unclear cause because some patients may have been undiagnosed or undocumented.…”

Section: Discussionmentioning

confidence: 91%

A model to predict the development of mental status changes of unclear cause after liver transplantation

Kanwal¹,

Chen

Ting

et al. 2003

Liver Transplantation

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Postoperative mental status changes are common after liver transplantation (LT). A clear cause of these mental status changes cannot be identified in a significant proportion of patients. In adult liver transplant recipients, our goals are to: (1) identify independent predictors for the development of post-LT mental status changes of unclear cause and (2) derive a practical formula to predict the risk for developing this complication by using simple clinical parameters. Eligible patients had documented mental status changes of at least 3 days' duration, occurring within 1 month of LT. Exclusion criteria were known structural brain disorders, major organ dysfunction, or metabolic causes of altered mentation. Age-and sex-matched controls were liver transplant recipients without post-LT neurological sequelae. Data were collected on preoperative, intraoperative, and postoperative variables.

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Section: Discussionmentioning

confidence: 91%

A model to predict the development of mental status changes of unclear cause after liver transplantation

Kanwal¹,

Chen

Ting

et al. 2003

Liver Transplantation

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“…6 Compared with azathioprine, MMF seems to be a more powerful immunosuppressive drug. 7 It has been used in the setting of kidney, 7 liver, 17 heart, 18 and lung 19 transplantation and in the treatment of autoimmune diseases, such as Wegener' s granulomatosis, microscopic polyangiitis, immunoglobulin A nephropathy, 20 and other glomerular diseases. 21 In the setting of OLT, the use of MMF seems to allow a reduction in cyclosporine or tacrolimus dose and therefore decreased toxicity.…”

Section: Discussionmentioning

confidence: 99%

Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil

et al. 1999

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The management of liver transplant recipients with renal function impairment remains controversial because cyclosporine withdrawal from triple immunosuppression regimens may be followed by graft rejection. A nonnephrotoxic and powerful immunosuppressant such as mycophenolate mofetil (MMF) could allow a reduction of cyclosporine dosage or its withdrawal and an improvement in renal function in these patients. Eleven patients with serum creatinine levels greater than 1.5 mg/dL, normal graft function, and a rejection-free period of at least 1 year started MMF at a dose of 2000 mg/d (reduced in case of adverse events) while cyclosporine dosage was slowly reduced. At last follow-up (63 ؎ 5 weeks), 7 patients remained free of cyclosporine (6 of those patients are also free of steroids), 2 patients reduced their cyclosporine dose, and 2 patients developed mild acute rejection that responded to a switch to tacrolimus therapy. Serum creatinine and urea levels in the 7 patients free of cyclosporine decreased from 2.22 ؎ 0.13 to 1.90 ؎ 0.19 mg/dL (P ‫؍‬ .05) and 0.95 ؎ 0.10 to 0.60 ؎ 0.10 g/L (P F .001), respectively. Creatinine clearance increased from 38.16 ؎ 5.60 to 47.01 ؎ 6.76 mL/min (P ‫؍‬ .005). Control of arterial hypertension also improved. Tolerance to MMF was good, but 6 patients required dose reductions, mainly because of asymptomatic anemia. In conclusion, in liver transplant recipients with stable graft function, MMF may allow cyclosporine dose reduction or discontinuation, thus improving renal function and the control of arterial hypertension. This change of treatment must be carefully monitored because of the frequent need for MMF dose reduction and the risk for rejection.

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“…Calcineurin may modulate glutamatergic neurotransmission via both pre-and postsynaptic sites of action [73]. Studies with dissociated rat hippocampal neurons have shown that the CsAcyclophilin complex interferes with GABA-mediated responses, suggesting that calcineurin may regulate desensitization of GABA receptors [51].…”

Section: Alteration Of Sympathetic Outflowmentioning

confidence: 99%

Neurotoxicity of calcineurin inhibitors: impact and clinical management

Bechstein¹

2000

Transplant Int

476

284

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Between 10 %-28 % of patients who receive the immunosuppressant cyclosporine (CsA) experience some form of neurotoxic adverse event. Both sensorial motoric functions may be adversely affected, and thus patients present with a wide range of neurological and psychiatrical disorders. Mild symptoms are common and include tremor, neuralgia, and peripheral neuropathy. Severe symptoms affect up to 5 % of patients and include psychoses, hallucinations, blindness, seizures, cerebellar ataxia, motoric weakness, or leukoencephalopathy.

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Mycophenolate mofetil added to immunosuppression after liver transplantation - first results

Cited by 22 publications

References 11 publications

A model to predict the development of mental status changes of unclear cause after liver transplantation

A model to predict the development of mental status changes of unclear cause after liver transplantation

Conversion of liver transplant recipients on cyclosporine with renal impairment to mycophenolate mofetil

Neurotoxicity of calcineurin inhibitors: impact and clinical management

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