70
5th International Conference on New Trends in Clinical and Experimental
Immunosuppression
MMF TREATMENT IN PATIENTS WITH HCV REINFECTION
AFTER LIVER TRANSPLANTATION: INFLUENCE ON
CLINICAL COURSE AND HISTOLOGICAL DAMAGE
Marcus Bahra Ulf P. Neumann Jan M. Langrehr Martin Harren Dietmar Jacob Thomas
Berg Ruth Neuhaus Peter Neuhaus
Berlin, Germany
Background: The inositol-monophosphate-dehydrogenase inhibitor MMF has
emerged to a standard immunosuppressant after orthotopic liver transplantation
(OLT) and is proposed to have antiviral effects. The aim of the study was to evaluate
whether MMF treatment improves outcome in patients with hepatitis C reinfection
after OLT with special emphasize on the histological course. Methods: Retrospective
analysis of 40 patients with histologically proven hepatitis C recurrence after
orthotopic liver transplantation under MMF treatment. Mean follow up after OLT was
24 months. MMF dosage ranged between 500 to 2000mg/d. Immunosuppression
consisted of tacrolimus (n = 34 ), cyclosporine ( n = 5 ) and rapamune ( n = 1 )
combined with MMF. Liver biopsies were performed routinely and histological
changes were scored for inflammation (scored from 0 to 3 points) and fibrosis
(scored from 0 to 4 points). Results: Indications for MMF treatment were:
Reinfection (n = 25) with normalisation of transaminases in 71% of patients.
Rejection (n = 6) with normalisation of transaminases in 83%. Initial MMF -
treatment was performed in five patients .For treatment of elevated creatinine/blood
urea MMF was given in three patients with normalisation of creatinine/ blood urea in
100% of patients .Switch from FK 506 to MMF due to neurotoxic effects in one
patient with normalisation of neurology. The histological analysis of liver biopsies
regarding inflammation showed an average of 1.5 points prior to MMF treatment.
After a meantime of 24 months of treatment, the histological scores showed no
changes (1.5 points). Fibrosis was scored by point prior to MMF treatment without
changes after 24 months of treatment (1 point). No changes in viral load measured
by HCV - RNA were seen. Conclusion: The antiviral properties of MMF measured
by HCV-RNA could not be confirmed in our study. However, most of the patients
showed a normalisation of transaminases after MMF treatment. Comparisons of
histological findings for fibrosis and inflammation showed no degradation of
histology during MMF treatment. Additional MMF showed good results for
treatment of acute rejection without steroid application in 5 of 6 patients. Virus-
activation due to steroid application could be avoided in these patients. Although no
direct antiviral effects of MMF could be observed, MMF seems to improve the
clinical course of HCV reinfection after OLT.