Liver Disease Clinical Trial
Official title:
CellCept (Mycophenolate Mofetil, MMF) Maintenance Immunosuppression in Liver Transplant Recipients With Long-term Follow-up Post-transplantation for Non-Autoimmune Liver Disease - A Prospective, Randomized, Multicenter Trial.
The purpose of the study is to assess the safety and efficacy of mycophenolate mofetil alone, or with reduced dose cyclosporine (CsA) or tacrolimus, for immunosuppression long-term after liver transplantation, in an attempt to reduce the potential side effects from using cyclosporine or tacrolimus.
Most liver transplant recipients receive an immunosuppressive drug regimen that contains
either cyclosporine or tacrolimus. Although these drugs have revolutionized transplantation,
in many patients their long-term use is a major cause of serious side effects, including
kidney failure, hypertension, diabetes mellitus, hyperlipidemia, and/or neurologic side
effects. Stopping or reducing the dose of cyclosporine or tacrolimus can ameliorate the
above side effects but may increase the risk of rejection. Mycophenolate mofetil (MMF), a
safe and effective immunosuppressant that does not cause the above side effects, is
typically used in combination with cyclosporine or tacrolimus. Attempts in liver transplant
recipients at using mycophenolate mofetil alone or with reduced dose cyclosporine or
tacrolimus have been successful but some patients developed rejection, and a few patients
suffered liver failure. Most rejections after liver transplantation are easy to successfully
treat with increased immunosuppression, but such treatment may carry risks such as increased
susceptibility to infection. There have not yet been any large trials to adequately assess
the safety and efficacy of using mycophenolate mofetil this way (alone or with reduced dose
calcineurin inhibitor (CNI)).
The purpose of this trial is to evaluate whether mycophenolate mofetil as monotherapy or
with reduced dose cyclosporine or tacrolimus long-term after liver transplantation is safe
and decreases side effects related to calcineurin inhibitor use.
Only liver recipients expected to have a relatively low risk of developing rejection and/or
liver failure are eligible for this trial. Some reasons for considering them low risk are
their stable liver function, having had the transplant for over a year, having had one or
fewer prior rejection episodes, having had non-autoimmune liver disease, their currently
requiring low dose/level cyclosporine or tacrolimus, and the plan to use high dose
mycophenolate mofetil and to exclude patients that fail to attain target values for
mycophenolic acid area under the concentration-time curve (MPA AUC - MycoPhenolic Acid Area
Under the Curve).
Eligible patients will be randomized to receive either mycophenolate mofetil monotherapy
(MMF; CNI discontinued), or mycophenolate mofetil and half their baseline dose of
calcineurin inhibitor (MMF; CNI decreased). The primary outcome is biopsy proven rejection
and the secondary outcomes include patient and graft survival, adverse events, hepatic
profile, blood pressure, renal function, diabetes, and lipid profile. Additionally,
mycophenolic acid concentrations will be measured; a mycophenolate mofetil monotherapy trial
provides unique opportunity to study the implications of such monitoring. Patients will be
followed for 12 months; there will be 16 visits during the trial.
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Allocation: Randomized, Endpoint Classification: Safety/Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Treatment
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