精挑细选肝移植人群的精确免疫抑制：MMF能单独“守住堡垒”吗？

IF 0.8 4区医学 Q4 IMMUNOLOGY

Transplantation proceedings Pub Date : 2025-07-01 DOI:10.1016/j.transproceed.2025.05.034

Bashar Fteiha , Ambreen Anil Merchant , Soongjin Ahn , James Trotter

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引用次数: 0

摘要

背景：关于霉酚酸酯（MMF）在肝移植中作为独立免疫抑制剂的数据很少，它通常与钙调磷酸酶抑制剂（CNIs）一起使用，或者很少与雷帕霉素抑制剂的哺乳动物靶点一起使用。方法：我们根据以下纳入标准对医疗记录进行回顾性审查：CNI伴或不伴MMF，原位肝移植后至少6个月，12个月内无排斥反应，移植后病程稳定，既往无移植史，无自身免疫性疾病史（原发性胆道炎、原发性硬化性胆管炎或自身免疫性肝炎）。患者在4周内逐步断奶CNI或哺乳动物雷帕霉素抑制剂靶点，如果不是MMF，则在4周内逐步引入。每1 - 2周监测肝功能，持续2 - 3个月。该研究的主要结果是过渡到MMF单药治疗后的排斥发生率。次要结局包括随访期间移植物丢失或患者死亡。结果：33例肝移植术后成功过渡到MMF单药治疗。其中，27例患者（81.8%）成功脱离cni。移植至MMF单药治疗的平均间隔时间为84±76个月，平均随访时间为8±4个月。肌酐水平平均降低0.6648±0.62 mg/dL。6例患者（18.2%）发生急性排斥反应，只有1例患者发生严重排斥反应需要住院治疗；其余作为门诊患者，其中一些需要重新引入CNI。结论：MMF单药治疗是肝移植后患者的可行选择，具有显著的成功率和潜在的肾脏益处。然而，仔细的监测对于及时识别和处理急性排斥反应是必不可少的。

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Precision Immunosuppression in a Carefully Selected Liver Transplant Population: Can MMF Alone “Hold the Fort “?

Background

Data on mycophenolate mofetil (MMF) as a standalone immunosuppressant in liver transplants are scarce, with it typically being used alongside calcineurin inhibitors (CNIs) or, less frequently, mammalian target of rapamycin inhibitors.

Methods

We conducted a retrospective review of medical records with the following inclusion criteria: on CNI with or without MMF, at least 6 months from orthotopic liver transplantation, absence of rejection episodes within 12 months, stable post-transplant course, no history of previous transplantation, and no history of autoimmune diseases (primary biliary cholangitis, primary sclerosing cholangitis, or autoimmune hepatitis). Patients were weaned from CNI or mammalian target of rapamycin inhibitors progressively over 4 weeks and, if not on MMF, it was introduced progressively over 4 weeks. Liver function tests were monitored every 1 to 2 weeks for 2 to 3 months. The primary outcome of the study was the incidence of rejection after the transition to MMF monotherapy. Secondary outcomes include graft loss or patient death during follow-up.

Results

Thirty-three patients after liver transplantation were transitioned successfully to MMF monotherapy. Of these, 27 patients (81.8%) were successfully weaned off CNIs. The average interval between transplantation and initiation of MMF monotherapy was 84 ± 76 months, with an average follow-up duration of 8 ± 4 months. The average mean reduction in creatinine levels was 0.6648 ± 0.62 mg/dL. Acute rejection was documented in 6 patients (18.2%), with only 1 patient experiencing severe rejection requiring hospitalization; the others were managed as outpatients, with some requiring CNI reintroduction.

Conclusion

MMF monotherapy is a viable option for select patients after liver transplantation, with a substantial success rate and potential renal benefits. However, careful monitoring is essential to identify and manage cases of acute rejection promptly.

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来源期刊

Transplantation proceedings 医学-免疫学

CiteScore

1.70

自引率

0.00%

发文量

502

审稿时长

60 days

期刊介绍： Transplantation Proceedings publishes several different categories of manuscripts, all of which undergo extensive peer review by recognized authorities in the field prior to their acceptance for publication. The first type of manuscripts consists of sets of papers providing an in-depth expression of the current state of the art in various rapidly developing components of world transplantation biology and medicine. These manuscripts emanate from congresses of the affiliated transplantation societies, from Symposia sponsored by the Societies, as well as special Conferences and Workshops covering related topics. Transplantation Proceedings also publishes several special sections including publication of Clinical Transplantation Proceedings, being rapid original contributions of preclinical and clinical experiences. These manuscripts undergo review by members of the Editorial Board. Original basic or clinical science articles, clinical trials and case studies can be submitted to the journal?s open access companion title Transplantation Reports.