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Copyright ©2006 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Aug 14, 2006; 12(30): 4870-4872
Published online Aug 14, 2006. doi: 10.3748/wjg.v12.i30.4870
Efficacy of mycofenolate mofetil for steroid-resistant acute rejection after living donor liver transplantation
Nobuhisa Akamatsu, Yasuhiko Sugawara, Sumihito Tamura, Yuichi Matsui, Junichi Kaneko, Masatoshi Makuuchi
Nobuhisa Akamatsu, Yasuhiko Sugawara, Sumihito Tamura, Yuichi Matsui, Junichi Kaneko, Masatoshi Makuuchi, Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
Author contributions: All authors contributed equally to the work.
Supported by grant-in-aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan and grants-in-aid for Research on HIV/AIDS and Measures for Intractable Diseases from the Ministry of Health, Labor and Welfare of Japan
Correspondence to: Yasuhiko Sugawara, MD, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan. yasusuga-tky@umin.ac.jp
Telephone: +81-3-38155411
Received: April 18, 2006
Revised: May 1, 2006
Accepted: May 22, 2006
Published online: August 14, 2006
Abstract

AIM: To discuss the use of mycophenolate mofetil (MMF) as an immunosuppressant in steroid resistant rejection after liver transplantation.

METHODS: The clinical records of 260 adult patients who underwent living donor liver transplantation (LDLT) were reviewed. Tacrolimus and methylprednisolone were used for primary immunosuppression. Acute rejection was first treated with steroids. When steroid resistance occurred, the patient was treated with a combination of steroids and MMF. Anti-T-cell monoclonal antibody was administered to patients who were not responsive to steroids in combination with MMF.

RESULTS: A total of 90 (35%) patients developed acute rejection. The median interval time from transplantation to the first episode was 15 d. Fifty-four patients were steroid resistant. Forty-four patients were treated with MMF and the remaining 10 required anti-T-cell monoclonal antibody treatment. Progression to chronic rejection was observed in one patient. Bone marrow suppression and gastrointestinal symptoms were the most common side effects associated with MMF use. There was no significant increase in opportunistic infections.

CONCLUSION: Our results demonstrate that MMF is a potent and safe immunosuppressive agent for rescue therapy in patients with acute rejection after LDLT.

Keywords: Tacrolimus; Rejection; Liver transplantation