AUTHOR=Jiménez-Romero Carlos , Justo Alonso Iago , Caso Maestro Oscar , Manrique Municio Alejandro , García-Sesma Álvaro , Calvo Pulido Jorge , Cambra Molero Félix , Loinaz Segurola Carmelo , Martín-Arriscado Cristina , Nutu Anisa , Marcacuzco Quinto Alberto TITLE=Indications and Long-Term Outcomes of Using Mycophenolate Mofetil Monotherapy in Substitution for Calcineurin Inhibitors in Liver Transplantation JOURNAL=Transplant International VOLUME=38 YEAR=2025 URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.13790 DOI=10.3389/ti.2025.13790 ISSN=1432-2277 ABSTRACT=

Switching the use of calcineurin inhibitors (CNIs), as basal immunosuppression in liver transplantation (LT) patients, for that of mycophenolate mofetil monotherapy (MMF-MT) is currently considered a good measure in recipients with chronic kidney disease (CKD) and other CNI-related adverse effects. We analyzed a retrospective cohort series of 324 LT patients who underwent long-term follow-up and were switched from CNI immunosuppression to MMF-MT due to CKD and other CNI-related adverse effects (diabetes, hypertension, infection). The median time on MMF-MT was 78 months. The indication for MMF-MT was CKD alone or associated with CNI-related adverse effects in 215 patients, diabetes in 61, hypertension in 42, and recurrent cholangitis in 6. Twenty-four (7.4%) patients developed non-resistant acute rejection post-MMF-MT, and 48 (14.8%) patients experienced MMF-related adverse effects, with MMF-MT withdrawn in only 8 (2.5%) patients. In the comparison between the pre-MMF-MT period and the last outpatient review, using a repeated measures model and taking each patient as its own comparator, we demonstrated a significant increase in GFR and significant decrease in creatinine and ALT values, remaining the other variables (diabetes, hypertension, and hematological and AST) within similar levels. Five-year survival post-MMF-MT conversion was 75.3%. MMF-MT significantly improved renal function, was well tolerated, and had a low rejection rate.