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Ann Hepatol. 2017 Jan-Feb 2017;16(1):94-106. doi: 10.5604/16652681.1226820.

 Conversion to mycophenolate mofetil monotherapy in liver recipients: Calcineurin inhibitor levels are key.

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Departamentos de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile.
Departamentos de Gastroenterología y Nutrición Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile.
Institute of Liver Studies, MRC Centre for Transplantation, King's College London, London SE5 9RS, United Kingdom.
Patología y Escuela de Medicina, Pontificia Universidad Católica de Chile.
Hemato-Oncología, Escuela de Medicina, Pontificia Universidad Católica de Chile.


 The use of calcineurin inhibitors (CNI) after liver transplantation is associated with post-transplant nephrotoxicity. Conversion to mycophenolate mofetil (MMF) monotherapy improves renal function, but is related to graft rejection in some recipients. Our aim was to identify variables associated with rejection after conversion to MMF monotherapy. Conversion was attempted in 40 liver transplant recipients. Clinical variables were determined and peripheral mononuclear blood cells were immunophenotyped during a 12-month follow-up. Conversion was classified as successful (SC) if rejection did not occur during the follow-up. MMF conversion was successful with 28 patients (70%) and was associated with higher glomerular filtration rates at the end of study. It also correlated with increased time elapsed since transplantation, low baseline CNI levels (Tacrolimus ≤ 6.5 ng/mL or Cyclosporine ≤ 635 ng/mL) and lower frequency of tacrolimus use. The only clinical variable independently related to SC in multivariate analysis was low baseline CNI levels (p = 0.02, OR: 6.93, 95%, CI: 1.3-29.7). Mean baseline fluorescent intensity of FOXP3+ T cells was significantly higher among recipients with SC. In conclusion, this study suggests that baseline CNI levels can be used to identify recipients with higher probability of SC to MMF monotherapy. identification: NCT01321112.

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