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Posted: Sun Nov 22, 2009 6:48 pm    Post subject: Immune cells may play important role in progression of type
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generic food  order adipex online no prescription Although MMF acts similarly to AZA, it is a more effective immunosuppressant with fewer side effects rendering AZA use virtually obsolete in liver transplantation. As MMF does not cause nephrotoxicity or neurotoxicity, it has been widely use as a CNI-sparing agent and has been used in LT since the early 1990’s (69-71). When used in combination with tacrolimus and steroids versus tacrolimus and steroids in a randomized controlled trial, Jain et al reported that patients in the MMF group experienced fewer episodes of acute cellular rejection, similar patient and graft survival and improved renal function and lesser amount of maintenance steroids (72). However, the favorable effect of MMF was lost when MMF was stopped which occurred in 37 % of patients secondary to infections complications and bone marrow depression. MMF has also been evaluated for the treatment of refractory rejection in liver transplant recipients. In one retrospective study of 47 patients, MMF was added to Csa or tacrolimus with steroid-resistant rejection, of whom 12 did not respond to OKT3 (73). Liver function tests normalized in 81% of patients (follow-up biopsies were not reported) although gastrointestinal and hematological side effects occurred in 31.4%. Serum creatinine decreased significantly within two weeks of MMF with reduced CNI dosing and creatinine clearance increased within three months in 77.9% of patients treated with MMF and reduced dose CNI. Akamatsu et al reported that 81% of patients with steroid-resistant rejection after living donor liver transplantation responded to the addition on MMF and only 19% of patients required OKT3 (74). Although gastrointestinal and hematological side effects were common, there was no increased in the incidence of infections with the authors concluding MMF had a valuable role in the treatment of steroid-resistant rejection before the initiation of monoclonal antibodies.
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