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Mycophenolate mofetil combination therapy improves long‐term outcomes after liver transplantation in patients with and without hepatitis C
Author(s) -
Wiesner Russell H.,
Shorr Jolene S.,
Steffen Bettina J.,
Chu Alice H.,
Gordon Robert D.,
Lake John R.
Publication year - 2005
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20453
Subject(s) - medicine , tacrolimus , immunosuppression , hazard ratio , liver transplantation , gastroenterology , hepatitis c , proportional hazards model , cohort , transplantation , confidence interval
To evaluate the impact of mycophenolate mofetil (MMF) on long‐term outcomes of tacrolimus and corticosteroids, we analyzed data reported to the Scientific Registry of Transplant Recipients for 11,670 adult patients (3463 with hepatitis C [HCV]) who underwent primary, single‐organ, liver transplantation between 1995 and 2001. Patients who were discharged from the hospital on tacrolimus‐based immunosuppression with (n = 4466; n = 1323 HCV) or without MMF (n = 7204; n = 2140 HCV) were included in the analysis. Recipients treated at discharge with MMF, tacrolimus, and corticosteroids had significantly increased patient survival (81.0% vs. 77.0% at 4 years, P < 0.0001) and graft survival (76.4% vs. 72.9%, P < 0.0001), and lower rates of acute rejection (29.0% vs. 33.4%, P < 0.001) as compared to recipients treated at discharge with tacrolimus and corticosteroids alone. A trend toward lower rates of death from infection was observed (6.1% at 4 years for MMF vs. 7.1% at 4 years for tacrolimus and corticosteroids, P = 0.0508), but this result did not reach statistical significance. In multiple regression analyses, MMF triple therapy at discharge was associated with a reduced risk of death (hazard ratio [HR] = 0.77, P < 0.001), graft loss (HR = 0.81, P < 0.001), acute rejection (HR = 0.89, P = 0.002), and death from infectious complications (HR = 0.80, P = 0.007). Outcomes were similar for the cohort with HCV. In conclusion, the addition of MMF at discharge to tacrolimus‐based immunosuppression is associated with improved long‐term outcomes after liver transplantation in patients with and without HCV. (Liver Transpl 2005;11:750–759.)