Does Calcineurin Inhibitor Plus Mycophenolate Mofetil Combination Therapy Decrease the Risk of Late Acute Rejection after Liver Transplantation?.
10.4285/jkstn.2010.24.2.93
- Author:
Kwan Woo KIM
1
;
Sung Gyu LEE
;
Shin HWANG
;
Ki Hun KIM
;
Chul Soo AHN
;
Deok Bog MOON
;
Tae Yong HA
;
Gi Won SONG
;
Dong Hwan JUNG
;
Nam Kyu CHOI
;
Jeong Ik PARK
;
Gil Chun PARK
;
Young Dong YU
;
Pyung Jae PARK
;
Young Il CHOI
Author Information
1. Division of Hepatobiliary Surgery and Liver Transplantation , Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. sglee2@amc.seoul.kr
- Publication Type:Original Article
- Keywords:
Calcineurin inhibitor;
Mycophenolate mofetil;
Late acute rejection;
Liver transplantation
- MeSH:
Adult;
Calcineurin;
Follow-Up Studies;
Humans;
Immunosuppression;
Incidence;
Liver;
Liver Transplantation;
Mycophenolic Acid;
Rejection (Psychology);
Risk Factors;
Survival Rate;
Transplants
- From:The Journal of the Korean Society for Transplantation
2010;24(2):93-100
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: With advances in immunosuppression, graft and patient survival rates have increased significantly, but acute cellular rejection remains an important problem following liver transplantation (LT), and late acute rejection (LAR) occurs in a small percentage of recipients. Some risk factors for LAR have been identified, yet the cause of LAR has not been completely investigated. The efficacy of mycophenolate mofetil (MMF) administered in combination with calcineurin inhibitor (CNI) for reduction of LAR has been demonstrated. METHODS: Between January 2006 and August 2007, adult LT recipients (n=309) were enrolled in this study. Biopsy-proven acute rejection that occurred >6 months after LT was defined as LAR. The immunosuppression regimens, CNI or CNI plus MMF, were used continuously for at least 6 months after LT. The mean follow-up period was 34.8 months (range, 25~46 months). RESULTS: LAR occurred in 17 cases (5.5%). The incidence of LAR in the CNI (n=138) or CNI plus MMF groups (n=171) was 8.6% (n=12) and 2.9% (n=5), respectively (P=0.015). Multivariate Cox regression confirmed that CNI plus MMF versus CNI therapy is associated with a decreased risk of LAR (relative risk, 0.33; P=0.04). CONCLUSIONS: The incidence of LAR in the CNI plus MMF group was significantly lower than the CNI group. Thus, continuous use of CNI plus MMF may represent a better immunosuppression regimen to decrease the rate of LAR in LT recipients.
