The renal benefit of mycophenolate mofetil after liver transplantation

Background: The risk and benefit of adding mycophenolate mofetil (MMF) to a standard immunosuppressive regimen at the time of liver transplantation (LT) is not well described. Methods: We performed a retrospective case-control analysis comparing one-yr outcomes of all LT recipients at our institution treated with post-operative tacrolimus (TAC), MMF, and steroids vs. TAC and steroids. Results: A total of 101 LT recipients (50:51 case:control) were analyzed. Despite more renal dysfunction at LT, the MMF+TAC group had similar serum creatinine (Cr) and glomerular filtration rate (GFR) as the TAC group one-yr post-LT. In this time period, Cr decreased (1.57-1.22mg/dL, p=0.04) and GFR increased (57.5-65.1mL/min per 1.73m², p=0.05) in the MMF+TAC group, while Cr increased (1.11-1.35, p<0.01) and GFR declined (73.5-60.1, p<0.001) in the TAC group. These findings occurred without a difference in absolute rejection episodes, hospitalizations, infections, deaths, or time to above events (p>0.05). Subgroup analysis of patients stratified by pre-transplant renal dysfunction (Cr≥1.2mg/dL) supported the previous. MMF was reasonably well tolerated with a low rate of discontinuation. Conclusions: The use of adjunctive MMF immediately after LT may protect against calcineurin inhibitor nephrotoxicity, potentially without the need for dose reduction or increased risk of adverse events.