Mycophenolate mofetil and reduced doses of cyclosporine in pediatric liver transplantation with chronic renal dysfunction: changes in the immune responses

Pediatric Transplantation
Jorge R FerrarisDaniel D'Agostino

Abstract

The aim of this study was to study the incidence of chronic renal dysfunction in patients with more than 5 yr of follow-up following liver transplantation and to evaluate the benefit of decreasing cyclosporine A (CsA) dose combined with mycophenolate mofetil (MMF) on renal function and immune response in these patients. Between 1988 and 1994, 60 children were transplanted, and 86% survived >5 yr post-liver transplantation. Fourteen patients developed chronic renal dysfunction secondary to CsA toxicity as evaluated by renal biopsy. In 11 patients CsA dose was decreased to 40-90 mg/ml target levels and MMF 600 mg/m(2) twice daily was added to the immunosuppressive regimen. Plasma creatinine decreased (from 1.0 +/- 0.03 to 0.8 +/- 0.03 ng/dl, p < 0.007), creatinine clearance increased (from 66.8 +/- 3.0 to 99.2 +/- 6.3 ml/min/1.73 m(2), p < 0.002) and microalbuminuria decreased (from 21.0 +/- 8.6 to 3.6 +/- 1.1 mg/24 h, p < 0.05) after 12 months of CsA combined with MMF therapy. During combined therapy the proliferative, cytolytic response and cytotoxic antibodies showed no significant changes, whereas CD4/CD8 ratio increased (from 1.2 +/- 0.2 to 1.4 +/- 0.1, p < 0.05). Tumor necrosis factor-alpha secretion increased (p < 0.005) d...Continue Reading

References

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Citations

Apr 17, 2008·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Sangeeta Hingorani
May 22, 2007·Current Gastroenterology Reports·William R Treem
May 28, 2005·Transplantation Proceedings·D A Kelly
Jul 16, 2014·Clinics in Liver Disease·Paige M PorrettAbraham Shaked
Apr 5, 2011·Gastroenterología y hepatología·M Trinidad Serrano AullóSara Lorente Pérez
May 6, 2009·Pediatric Transplantation·Dominic Dell-Olio, Deirdre A Kelly
Feb 16, 2007·Pediatric Transplantation·Jorge R FerrarisNorma Prigoshin
Nov 8, 2012·Pediatric Transplantation·Robyn Greenfield MatloffJeffrey M Saland
Jun 9, 2012·Pediatric Transplantation·Paula Alejandra Coccia, Jorge Roberto Ferraris
Mar 25, 2010·Pediatric Transplantation·Gustaf HerleniusStyrbjörn Friman
Oct 4, 2011·Journal of Hepatology·Patrizia Burra
Nov 14, 2006·Pediatric Transplantation·J Michael TredgerAnil Dhawan
Dec 26, 2009·Paediatric Drugs·Kristine S SchonderRobert J Weber
Nov 16, 2005·Transplantation·Jochen KluppPeter Neuhaus
Feb 12, 2019·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Nima MemaranAnette Melk
Sep 20, 2020·Clinical Transplantation·Antonio LacquanitiPaolo Monardo
Jun 19, 2015·World Journal of Hepatology·Christina HacklMartin Loss

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