Mycophenolate Mofetil Use Is Associated with Decreased Risk of Late Acute Rejection in Adult Liver Transplant Recipients
Article first published online: 23 MAY 2006
American Journal of Transplantation
Volume 6, Issue 7, pages 1609–1616, July 2006
How to Cite
Wiesner, R. H., Steffen, B. J., David, K. M., Chu, A. H., Gordon, R. D. and Lake, J. R. (2006), Mycophenolate Mofetil Use Is Associated with Decreased Risk of Late Acute Rejection in Adult Liver Transplant Recipients. American Journal of Transplantation, 6: 1609–1616. doi: 10.1111/j.1600-6143.2006.01382.x
- Issue published online: 23 MAY 2006
- Article first published online: 23 MAY 2006
- Received 29 July 2005, revised 14 March 2006 and accepted for publication 14 March 2006
- Graft survival;
- late acute rejection;
- long-term outcomes;
- patient survival
Mycophenolate mofetil (MMF) used in a triple-drug regimen has been shown to decrease acute rejection rates, compared to a double-drug regimen. The impact of MMF on late acute rejection (LAR) episodes has not been well described.
To investigate the risk of LAR (rejection ≥6 months post-transplantation) data from the Scientific Registry of Transplant Recipients (SRTR) were used. We studied adult primary liver transplant recipients transplanted between June 1, 1995, and April 30, 2004, with hepatitis C virus (HCV) (n = 3356), hepatitis B virus (HBV) (n = 550) or a nonviral (n = 5740) primary cause of liver disease who were recorded as receiving continuous 3-(MMF + Tacro + steroids) versus 2-drug (Tacro + steroids) therapy for at least 6 months immediately post transplantation.
Kaplan–Meier analysis showed significantly lower LAR rates 4 years post-transplant in 3- versus 2-drug HCV, HBV and nonviral disease patients. Multivariate regression confirmed 3- versus 2-drug therapy to be associated with a decreased risk of LAR. Late graft survival was significantly lower at 4 years post-transplant for patients with LAR 6–12 months post-transplantation versus patients with early rejection (78.0% vs. 87.0%, p < 0.001) and no rejection (88.1%, p < 0.001).
Three-drug versus 2-drug therapy for a minimum of 6 months may offer a better treatment strategy to avoid the consequences and expense of LAR episodes.