ArticleClinical transplantation2026
"Mycophenolate-Based Immunosuppression After Calcineurin-Inhibitor Withdrawal in Liver Transplant Recipients is Safe and Results in Long-Term Improvement in Renal Function".
Article in Clinical transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionRenal dysfunction is an important side effect of calcineurin inhibitors (CNI) and is associated with worse outcomes after liver transplantation (LT). Prior studies on mycophenolate-based (MMF), CNI-free immunosuppression regimens have raised concerns about the risk of rejection (ACR). We evaluated the long-term impact of transition from CNI to MMF-based immunosuppression on long-term renal function and other clinical outcomes.
methodsWe performed a single-center, retrospective review of LT recipients from 1/1/2008 to 12/31/2021 who were transitioned from CNI- to MMF-based immunosuppression for renal dysfunction. Primary outcome was mean change in eGFR at 1- and 5-years after CNI withdrawal: a sequential stratification model was then used to compare changes in eGFR to a control group comprising patients maintained on CNIs at last follow-up date. Secondary outcomes included first episode of acute cellular rejection (ACR), graft survival and patient survival.
resultsFifty-one patients were switched to a MMF-based immunosuppression regimen at median time of 29.1 months after LT and were then followed for median 93.2 months. Mean age at time of LT was 57.5 years old, 41 (80.4%) patients were male, 44 (86.3%) patients were white and 16 (32.7%) patients had a history of hepatitis C. Model-based estimates of the increase in eGFR-CKD-Epi were 5.7 (95% CI: 2.4, 9.0, p = 0.001) mL/min per 1.73 m
conclusionsThe use of MMF-based immunosuppression after CNI withdrawal results in long-term improvement in renal function without significantly increasing the risk of ACR. As more LT recipients present with and develop renal dysfunction in the post-MELD era, conversion to a MMF-based immunosuppression to preserve kidney function is both safe and effective.
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