Uncommon Side Effect of MMF in Renal Transplant Recipients

Figures & data

Table 1. Liver function tests of the patients

Parameters	I Median (min–max)	II Median (min–max)	III Median (min–max)	P value (I–II)	P value (I–III)	P value (II–III)
AST (U/L)	14.0 (8–34)	83.0 (50–123)	19.0 (14–32)	0.000	0.23	0.000
ALT (U/L)	22.0 (3–22)	222.0 (51–508)	33.0 (21–64)	0.004	0.013	0.005
ALP (U/L)	214.5 (168–427)	271.0 (194–489)	263.0 (144–331)	0.837	0.981	0.878
GGT (U/L)	26.0 (12–34)	38.5 (24–194)	34.0 (18–117)	0.196	0.457	0.993
T.Biluribin (mg/dL)	0.5 (0.2–1.1)	0.5 (0.19–1.10)	0.63 (0.18–1.44)	0.959	0.677	0.922
D.Biluribin (mg/dL)	0.1 (0–0.2)	0.1 (0.04–0.25)	0.18 (0.02–0.55)	0.972	0.582	0.741

Liver enzymes levels I-waiting list, II-first elevation, III-after discontinuation of MMF.

Table 2. The laboratory values of the patients with elevated liver enzymes

Patients	ASTII	ALTII	ALPII	GGTII	T.BilII	D.BilII	AST III	ALTIII	ALPIII	GGTIII	T.BilIII	D.BilIII	*	†	‡	Φ	§
1	57	110	286	41	0,75	0,25	19	39	313	117	1,13	0,41	63	2	0	15	38
2	81	329	301	76	0,46	0,13	19	29	178	29	0,94	0,27	70	2	0	20	16
3	91	51	194	–	0,6	0,1	20	23	227	18	0,26	0,02	20	2	1	3	4
4	112	508	224	32	0,8	0,2	18	34	144	–	0,25	0,09	4	2	0	4	19
5	50	222	–	–	1,1	0,2	16	33	238	34	0,63	–	17	2	0	30	16
6	72	84	264	30	0,21	0,05	14	23	282	26	0,45	0,13	8	2	1	4	7
7	123	74	202	24	0,5	0,18	32	28	174	26	0,51	0,18	55	2	1	5	7
8	65	352	278	36	0,6	0,09	26	40	263	40	0,7	0,1	28	2	1	11	6
9	84	92	232	–	0,19	0,04	24	21	322	34	0,18	–	23	2	1	3	7
10	83	279	334	194	0,38	0,09	30	64	275	67	1,44	0,55	60	2	0	96	178
11	93	345	489	72	0,43	0,1	15	38	331	44	0,8	0,2	52	2	0	88	146

*The day of elevation of liver enzymes after renal transplantation.

†The MMF dose (g/day) after renal transplantation.

‡Action after elevations of liver enzymes: Dose reduction (1 g) or withdrawl of MMF (0).

ΦPersistence time of high liver enzyme levels.

§Resolution period of hepatotoxicity after discontinuation or reduced dosage of MMF.

Figure 1 The median levels of ALT I, II, and III.

Figure 2 The correlation between the persistence duration of elevated ALT levels and recovery duration after MMF dose adjustment.

Figure 3 The risk of MMF associated hepatotoxicity after renal transplantation.