Outcome Of Mycophenolate Mofetil Intolerant Liver Transplant Recipients: Hangzhou Experience

Background:Liver transplantation is the only effective method to treat end-stage liver disease. As a non-nephrotoxic immunosuppressant following liver transplantation, mycophenolate mofetil(MMF) possesses side effects such as bone marrow suppression, and gastrointestinal disorders, resulting in the existence of patients who are intolerant of MMF. This study aims to explore the complications and outcome of MMF-intolerant patients treated with MMF-free immunosuppressive regimens after liver transplantation, and summarizes a single center experience in application of immunosuppressive regimens in MMF-intolerant liver transplant recipients.Methods:Altogether 188 patients undergoing liver transplantation from January 2008 to December 2009 were reviewed. The preoperative data and postoperative complication rates were compared between MMF-free group (24 cases, tacrolimus(FK506)+steroid or FK506 regimen without steroid) and MMF group (48 cases, FK506+MMF+steroid or FK506+MMF regimen) as a control. Results:The mean follow-up time for liver transplant recipients in MMF-free group and MMF group was 12.4 and 14.0 months, respectively. Preoperative levels of white blood cell, hemoglobin and platelet in MMF-free group were significantly lower than that in the MMF group, respectively (2.1±0.9)*109/Lvs.(5.5±3.3)*109/L,P<0.01; 93±23g/L vs.106±27g/L, P=0.041; (38±21)*109/L vs.(84±66)*109/L, P<0.01). There was no significant difference between MMF-free group and MMF group in blood concentration of FK506 at 2nd day,1st week,2nd week,3rd week and 4th week after liver transplantation (P> 0.05). When acute rejection occurs, there was no significant difference in the blood concentration of FK506 between MMF-free group and MMF group (5.54±1.96 ng/ml vs.6.76±1.84 ng/ml, P>0.05). The incidence of acute rejection in MMF-free group was significantly higher than that in MMF group (45.8% vs.14.6%, P=0.004). The incidence of biopsy-proven acute rejection in MMF-free group was higher than that in MMF group (25% vs.10.6%), but the difference was not statistically significant (P=0.105), and about 63.6% acute rejection types in MMF-free group are considered to be mild rejection easy to be controlled. There was no significant difference between MMF-free group and MMF group in the rates of infection (62.5% vs. 43.8%, P=0.134), hypertension (8.3% vs.8.7%, P=0.959), diabetes (13% vs.4.5%, P=0.209), tumor recurrence (27.3% vs.38.5%, P=0.562), hepatitis B recurrence (0% vs.4.2%, P> 0.05) and patient survival (100% vs.93.8%, P> 0.05).Conclusion:For liver transplant recipients who are intolerant of MMF, MMF-free immunosuppressive regimen may increase the incidence of mild acute rejection,but does not affect infection, metabolic complications, tumor recurrence, HBV recurrence and patient survival after liver transplantation, so it is considered to be safe and feasible.