Triple immunosuppressive therapy using
mycophenolate mofetil (MMF), microemulsion
cyclosporine (me-CsA), and
prednisone offers the potential for potent immunosuppression without intravenous
drug therapy or
anti-T-cell antibody induction
therapy. This report describes the application of an immunosuppressive protocol (CNp) using MMF, me-CsA, and
prednisone as primary immunosuppression for pediatric
liver transplant recipients at the University of California at San Francisco. From August 1995 through December 1996, 26 children (17 boys, 9 girls) aged 1 month to 16 years (mean +/- standard deviation, 58 +/- 62 months; median, 31 months) underwent
liver transplantation at our institution, receiving CNp as primary immunosuppression. Posttransplantation renal function, incidence of
leukopenia, and drug tolerance within the group receiving CNp as primary immunosuppression were compared with those of 19 children who received primary immunosuppression consisting of
azathioprine, oil-based gel-encapsulated
cyclosporine, and
prednisone with
anti-T-cell antibody induction
therapy at the same institution from October 1993 through July 1995. No significant difference was observed between immunosuppressive protocols in serum
creatinine level or incidence of
leukopenia requiring medical
therapy during the first year posttransplantation. Whereas gastrointestinal symptoms were observed in approximately 30% of CNp recipients during initial
immunotherapy, tolerance of CNp primary
immunotherapy was routinely achieved by the
dose reduction of MMF. At 1 year posttransplantation, 20 children (77%) remained on CNp primary
immunotherapy, 5 children (19%) were receiving
tacrolimus-based
immunotherapy secondary to rejection, and 1 patient (4%) converted to
tacrolimus-based
immunotherapy secondary to persistent gastrointestinal intolerance. In conclusion, CNp provides an alternative immunosuppressive protocol that eliminates the necessity of intravenous and induction immunosuppressive therapy with no increased incidence of posttransplantation renal dysfunction or
leukopenia and is well tolerated in children.