Liver transplantationRecurrence of hepatitis c in liver transplant recipients treated with mycophenolate mofetil
Section snippets
Patients and methods
From 1989 to 1999, HCV-OLT was analyzed according to the type of immunosuppression received. MMF was mostly used as a rescue therapy for severe acute rejection or renal failure. Due to dose adjustments, an exposure ratio (ER) to MMF was established according to the following formula: where ER = exposure ratio to MMF; MMFTD = total dose of MMF in grams per day; EP = exposure period to a particular dose in
results
Most parameters presented no significant differences. Table 1 presents HCV RNA levels found before OLT and at 1 year after OLT according to the use and the amount of MMF. These results were associated with hepatitis C recurrence found at 1 year. Figure 1 shows the HCV RNA profile according to the degree of HCVR. No statistical differences were found among groups. Figure 1a shows a higher level of HCV-RNA for patients on a high-dose MMF and no HCVR. Figure 1b shows higher HCV-RNA levels for all
Summary
As opposed to the antiviral activity seen with MPA, MMF in rescue therapy did not show a direct antiviral action assessed by HCV RNA levels. The elevation of HCV RNA was not exclusive to MMF since it was also seen in patients on CSA + PRED alone and on CSA + PRED + azathioprine (data not shown). OLT patients who did not receive MMF had lower HCV RNA levels than patients who did but only in the no-HCVR subgroup. In progressive and aggressive HCVR, the levels were high. For patients on MMF
Conclusions
The benefit of MMF in delaying hepatitis C recurrence may be similar to that of ribavirin monotherapy, which has been reported to have a low impact in reducing the hepatitis C viral load.5, 6 Better immunosuppression may explain the delay in hepatitis C recurrence seen with MMF therapy. It could be hypothesized that the potential benefit of MMF in delaying the recurrence of hepatitis C posttransplantation may not be related to the antiviral activity, found in in vitro studies but to the
References (8)
- et al.
Antiviral Res
(1996) - et al.
Ann Thoracic Surg
(1994) - et al.
Antimicrob Agents Chemother
(1998) - et al.
Am J Surg Pathol
(1995)