Mycophenolate mofetil combination therapy improves long-term outcomes after liver transplantation in patients with and without hepatitis C

Russell H. Wiesner, Jolene S. Shorr, Bettina J. Steffen, Alice H. Chu, Robert D. Gordon, John R. Lake

Research output: Contribution to journalArticle

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Abstract

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.

Original languageEnglish (US)
Pages (from-to)750-759
Number of pages10
JournalLiver Transplantation
Volume11
Issue number7
DOIs
StatePublished - Jul 2005

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Mycophenolic Acid
Tacrolimus
Hepatitis C
Liver Transplantation
Adrenal Cortex Hormones
Immunosuppression
Therapeutics
Organ Transplantation
Graft Survival
Registries
Regression Analysis
Transplants
Survival
Mortality
Infection

ASJC Scopus subject areas

  • Surgery
  • Transplantation

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Mycophenolate mofetil combination therapy improves long-term outcomes after liver transplantation in patients with and without hepatitis C. / Wiesner, Russell H.; Shorr, Jolene S.; Steffen, Bettina J.; Chu, Alice H.; Gordon, Robert D.; Lake, John R.

In: Liver Transplantation, Vol. 11, No. 7, 07.2005, p. 750-759.

Research output: Contribution to journalArticle

Wiesner, Russell H. ; Shorr, Jolene S. ; Steffen, Bettina J. ; Chu, Alice H. ; Gordon, Robert D. ; Lake, John R. / Mycophenolate mofetil combination therapy improves long-term outcomes after liver transplantation in patients with and without hepatitis C. In: Liver Transplantation. 2005 ; Vol. 11, No. 7. pp. 750-759.
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abstract = "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.",
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