Use of Mycophenolate Mofetil as Rescue Therapy After Pediatric Liver Transplantation

Chardot, Christophe; Nicoluzzi, João Eduardo Leal; Janssen, M.; Sokal, Étienne; Lerut, Jan; Otté, Jean-Bernard; Reding, Raymond

doi:10.1097/00007890-200101270-00009

Cited by 66 publications

(46 citation statements)

References 27 publications

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“…In reviewing published series, it is clear that the use of calcineurin inhibitors, OKT3 and antithymocyte globulins (ATG), potently suppress recipient T cell function, which in turn contributes to the expansion of EBV-infected B cells, increasing the risk of PTLD [9,10]. On the other hand, the use of mycophenolate mofetil (MMF), sirolimus and anti-IL2 receptor monoclonal antibodies (Basiliximab, Daclixumab) has not been clearly associated with an increased risk of PTLD development after LTX [11][12][13].…”

Section: Immunosuppressionmentioning

confidence: 99%

Who is at risk for post-transplant lymphoproliferative disorders (PTLD) after liver transplantation?

Aucejo

Rofaiel

Miller

2006

Journal of Hepatology

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Section: Immunosuppressionmentioning

confidence: 99%

Who is at risk for post-transplant lymphoproliferative disorders (PTLD) after liver transplantation?

Aucejo

Rofaiel

Miller

2006

Journal of Hepatology

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“…It has been used with increasing frequency in solidorgan transplantation and has an adjuvant immunosuppressive effect when used with the calcineurin inhibitors cyclosporine (CsA) and tacrolimus (Tac) in both the prevention of acute rejection 1,2,4 and treatment of resistant or chronic rejection. [5][6][7] The pharmacokinetics of MPA, the major metabolite and active component of MMF, has been studied in healthy adult subjects, as well as adult and pediatric renal transplant recipients. 8,9 Despite its increasing use in pediatric liver transplant recipients, 7,10,11 pharmacokinetic studies of MPA in this population are lacking.…”

mentioning

confidence: 99%

“…[5][6][7] The pharmacokinetics of MPA, the major metabolite and active component of MMF, has been studied in healthy adult subjects, as well as adult and pediatric renal transplant recipients. 8,9 Despite its increasing use in pediatric liver transplant recipients, 7,10,11 pharmacokinetic studies of MPA in this population are lacking. Aims of this study are to: (1) describe the pharmacokinetics of MPA in a group of stable pediatric liver transplant recipients, (2) define whether single time points can reliably estimate total drug exposure, and (3) identify determinants of pharmacokinetic variability, including comedication with CsA and Tac.…”

mentioning

confidence: 99%

Mycophenolic acid pharmacokinetics in pediatric liver transplant recipients

Brown

Itsuka

et al. 2003

Liver Transplantation

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The aim of this study is to study mycophenolic acid (MPA) pharmacokinetics in stable pediatric liver transplant recipients and determine which times best represent the area under the concentration versus time curve (AUC) of MPA plasma concentrations. MPA pharmacokinetic profiles were determined in 21 liver transplant recipients (age, 2 to 15 years; 12 boys) administered mycophenolate mofetil (MMF) for at least 6 months. Ten patients were coadministered cyclosporine A (CsA), and 11 patients were coadministered tacrolimus (Tac). Plasma MPA levels were analyzed by enzyme-multiplied immunoassay technique in blood samples at 0, 0.33, 0.67, 1.25, 2, 3.5, 5, and 7 hours after MMF administration. The AUC of plasma concentrations to 7 hours (AUC 0-7 ) was calculated using the linear trapezoidal rule. MPA plasma trough concentration (C 0 ), maximal concentration, and AUC 0-7 values ranged 9-to 14-fold at a median of 1.

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“…If these patients were taking cyclosporine or tacrolimus as their main immunosuppressant, mycophenolate mofetil enabled a reduction in the dose of calcineurin inhibitors (CNI), and even their complete withdrawal in some cases, with a concomitant improvement in renal function [12][13][14][15][16][17]. A beneficial effect was also shown in the 62% of patients whose liver dysfunction was due to acute cellular rejection (Table 1).…”

Section: Immunosuppression and Its Complicationsmentioning

confidence: 99%

The adolescent and liver transplantation

Burra

2012

Journal of Hepatology

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The outcome of liver transplantation is usually reported in terms of graft and patient survival, medical and surgical complications, and quality of life, but when it comes to transplanted adolescents such conventional parameters are unable to give a full account of their life with a new liver, and their transition from adolescence to adulthood is a time when they are particularly vulnerable. Adolescents with liver transplants have excellent survival rates, over 80% of them surviving more than 10 years. Graft loss is most often associated with complications such as chronic rejection, hepatic artery thrombosis, and biliary complications. Calcineurin inhibitors may have various side effects, including hypertension and nephrotoxicity. Liver-transplanted adolescents are also exposed to viral infections, among which Epstein-Barr virus is very common and associated with the onset of post-transplant lymphoproliferative disorders. Growth retardation may also be an issue in some liver transplant recipients. Future studies will determine the best way to assess the functional immune status of adolescents with a transplanted liver with a view to ensuring the best treatment to induce tolerance without the complications of excessive immunosuppression. Schooling may be disrupted due to adolescent transplant recipients' poor adherence. Non-adherence is associated with a poor medical outcome. Both physical and psychosocial functioning is reportedly lower among young liver transplant recipients than in the general population.

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Use of Mycophenolate Mofetil as Rescue Therapy After Pediatric Liver Transplantation

Abstract: These preliminary results suggest that MMF is an effective and safe immunosuppressant in pediatric LT recipients. Its use is hampered by frequent gastrointestinal and hematological side-effects. MMF does not seem to increase the risk of PTLD nor CMV disease.

Cited by 66 publications

References 27 publications

Who is at risk for post-transplant lymphoproliferative disorders (PTLD) after liver transplantation?

Who is at risk for post-transplant lymphoproliferative disorders (PTLD) after liver transplantation?

Mycophenolic acid pharmacokinetics in pediatric liver transplant recipients

The adolescent and liver transplantation

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