Mycophenolate Mofetil Monotherapy in Patients Who Underwent Liver Transplantation for Hepatitis C Cirrhosis

Mycophenolate mofetil monotherapy in liver transplant recipients

“…This is lower than the cumulative rate of rejection (12%) in reported studies to date, although individual rates of rejection have varied significantly, ranging from 3% to as high as 60% (18, 25). Our study differs in that the taper of CNI was comparable (median 6.9 months) to previously reported studies with extended tapers (21, 25, 29, 30). In our study, the mean taper of the two patients who experienced rejection was 5.1 months compared to 15.0 months in the remaining study population.…”

“…Initially found to be efficacious as an adjunct to CNI in renal and cardiac transplant recipients, MMF has more recently been used to minimize side effects of CNI in LT recipients, particularly nephrotoxicity, by allowing for dose reduction or even withdrawal of CNI. While two initial prospective randomized trials of MMF monotherapy showed concerning rates of rejection and graft loss, subsequent retrospective and prospective studies have demonstrated lower rates of rejection, although long-term data are limited (13,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32). In the present study, we report a slow CNI tapering protocol to MMF monotherapy associated with long-term improvement in renal function, reduced CNI-related side effects, and a low rate of rejection.…”

Mycophenolate mofetil inhibits hepatitis C virus replication in human hepatic cells

“…Inhibition of IMPDH results in intracellular guanosine depletion, which is considered to be the antiviral mechanism of MMF against several viruses, including Dengue virus, HBV and HIV-1 as supplement by exogenous guanosine almost fully recovered viral replication (Diamond et al, 2002; Gong et al, 1999; Hossain et al, 2002; Khan et al, 2011; Sebastian et al, 2011; Takhampunya et al, 2006). Clinical studies of MMF effects on HCV have generated inconsistent data (Bahra et al, 2005; Fasola and Klintmalm, 2002; Firpi et al, 2003; Jain et al, 2002; Kornberg et al, 2005; Manrique et al, 2008; Marubashi et al, 2009; Ong et al, 1999; Platz et al, 1998; Rostaing et al, 2000; Zekry et al, 2004). In addition, little is known about the mechanism(s) of the MMF action on HCV.…”

“…The clinical effects of MMF on HCV infection, however, are still controversial. Several studies showed that MMF treatment of rejection reduced the incidence of HCV recurrence after liver transplantation (Bahra et al, 2005; Jain et al, 2002; Kornberg et al, 2005; Manrique et al, 2008; Marubashi et al, 2009; Platz et al, 1998), while others reported no change or a slight increase in HCV viral load when MMF was used to treat HCV-infected transplant recipients (Fasola et al, 2002; Firpi et al, 2003; Ong et al, 1999; Rostaing et al, 2000; Zekry et al, 2004). Furthermore, to date, it has not been demonstrated whether MMF has any direct effect on HCV infection/replication in vitro , although a pervious study (Henry et al, 2006) showed that mycophenolic acid (MPA), the active metabolite of MMF, has inhibitory effect on HCV replication in HCV replicon system.…”

Strategies to prevent or reduce acute and chronic kidney injury in liver transplantation

“…In another study conducted by Fairbanks and Thuluvath (86), MMF monotherapy was associated with an even higher risk of allograft rejection in 19% of LT recipients. Considering the results from available studies, MMF monotherapy is a very attractive option but the balance between efficacy and risk of rejection needs to be weighted (84, 86–89). Therefore, this therapeutic option should be restricted to patients with a low immunological risk.…”