Calcineurin-inhibitor related nephrotoxicity-reversibility in paediatric liver transplant recipients

Aim. To study the efficacy of mycophenolate mofetil. (MMF) as renal rescue in paediatric liver transplant recipients with calcineurin-inhibitor- (CI) related nephrotoxicity. Methods. Pediatric liver transplant recipients with stable graft function and a glomerular filtration rate (GFR) < 80 ml/min/1.73 m(2) were enrolled. MMF was introduced at 20 mg/kg/day and increased to 40 mg/kg/ day after 1 week. CI dose was then reduced 6 weeks to achieve blood levels 25% of baseline. GFR was reassessed after 6 and 12 months. Results. Fourteen children with a median (range) interval from transplant of 57 (4-111) months were studied. Their median (range) GFR in ml/min/1.73 m(2) increased from a baseline of 52 (31-71), to 69 (38-111) and 73 (35-98) at 6 and 12 months, respectively (P=0.00014). Side effects of MMF include leucopaenia in two and backache in one, two of whom discontinued MMF. Acute allograft rejection occurred in three children. All 14 are well with a median (range) follow-up of 24 (14-38) months from MMF introduction. Conclusion. MMF allows the recovery of renal function from CI related nephrotoxicity in more than 70% of paediatric liver transplant recipients with renal impairment.