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The management of renal function impairment after liver transplantation (LT) is difficult because cyclosporine A (CYA) dosage reduction may be followed by graft rejection. Previous pilot studies in kidney transplant recipients with CYA nephrotoxicity have shown that introduction of mycophenolate mofetil (MMF) and reduction of CYA dosage was followed of renal function improvement.
Aim. To assess whether partial or total conversion horn CYA-based immunosuppression to MMF results in improved renal function.
Patients and methods. Nine LT recipients with CYA-based immunosuppression (plus azathioprine and/or steroids), serum creatinine above 1.5 mg/dL, normal graft function and a period free of rejection of at least one year were started on MMF at a daily dose of 2000 mg (discontinuing azathioprine when applicable) and their CYA dose was slowly reduced (25 mg every 2 weeks) until discontinuation or worsening of liver function tests. Results. CYA was fully withdrawn in 6 patients (p) whereas it was reduced in 3 p to 37-6656 of the initial dose. Three p developed mild serum GPT increases that remained stable without further CYA dose reductions. No p had to stop MMF, but 4 p required dose reductions because anemia (3 p) and mild neutropenia (1p). After a mean±SEM follow-up of 6.11±0.77 (range 2 to 9) months, serum GPT and total bilirubin remained stable (mean±SEM; basal vs. last determination): 24±6 vs. 26±5 IU/L (P=NS) and 0.79±0.11 vs. 0.65±0.10 mg/dL (P=NS), respectively. Serum creatinine decreased in all but one p: 2.1±0.1 vs. 1.8±0.1 (P=0.01) and BUN decreased in all the p : 0.44±0.40 vs. 0.33±0.46 g/L (P<0.01). Eight p had arterial hypertension before conversion to MMF. In the last visit, 2 p were free of antihypertensive drugs, 416 p could reduce its number and 118 p required an increase of them (P=0.06). Conclusion. Partial or total conversion from CYA to MMF in stable LT recipients with renal function impairment is followed by renal function improvement and better control of arterial hypertension without biochemical evidence of graft damage.