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Mycophenolate mofetil, microemulsion cyclosporine, and prednisone as primary immunosuppression for pediatric liver transplant recipients
Author(s) -
Renz John F.,
Lightdale Jennifer,
Mudge Christine,
Bacchetti Peter,
Watson Jennifer,
Ascher Nancy L.,
Emond Jean C.,
Rosenthal Philip,
Roberts John P.
Publication year - 1999
Publication title -
liver transplantation and surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1074-3022
DOI - 10.1002/lt.500050208
Subject(s) - immunosuppression , medicine , prednisone , tacrolimus , leukopenia , gastroenterology , azathioprine , transplantation , immunology , chemotherapy , disease
Triple immunosuppressive therapy using mycophenolate mofetil (MMF), microemulsion cyclosporine (me‐CsA), and prednisone offers the potential for potent immunosuppression without intravenous drug therapy or anti–T‐cell antibody induction therapy. This report describes the application of an immunosuppressive protocol (CNp) using MMF, me‐CsA, and prednisone as primary immunosuppression for pediatric liver transplant recipients at the University of California at San Francisco. From August 1995 through December 1996, 26 children (17 boys, 9 girls) aged 1 month to 16 years (mean ± standard deviation, 58 ± 62 months; median, 31 months) underwent liver transplantation at our institution, receiving CNp as primary immunosuppression. Posttransplantation renal function, incidence of leukopenia, and drug tolerance within the group receiving CNp as primary immunosuppression were compared with those of 19 children who received primary immunosuppression consisting of azathioprine, oil‐based gel‐encapsulated cyclosporine, and prednisone with anti–T‐cell antibody induction therapy at the same institution from October 1993 through July 1995. No significant difference was observed between immunosuppressive protocols in serum creatinine level or incidence of leukopenia requiring medical therapy during the first year posttransplantation. Whereas gastrointestinal symptoms were observed in approximately 30% of CNp recipients during initial immunotherapy, tolerance of CNp primary immunotherapy was routinely achieved by the dose reduction of MMF. At 1 year posttransplantation, 20 children (77%) remained on CNp primary immunotherapy, 5 children (19%) were receiving tacrolimus‐based immunotherapy secondary to rejection, and 1 patient (4%) converted to tacrolimus‐based immunotherapy secondary to persistent gastrointestinal intolerance. In conclusion, CNp provides an alternative immunosuppressive protocol that eliminates the necessity of intravenous and induction immunosuppressive therapy with no increased incidence of posttransplantation renal dysfunction or leukopenia and is well tolerated in children.