Abstract
【Objective】We investigated the efficacy and safety of mizoribine (MZR) for treatment-resistant rejection after a living-donor liver transplantation (LDLT) under an immunosuppressive regimen of tacrolimus (Tac) and low-dose steroids.
【Methods】Thirty patients who suffered acute cellular rejection (group M: moderate rejection, n=11; group S: severe rejection, n=7; and group R: treatment-resistant rejection, n=12) were treated additionally with MZR at 2―3 mg/kg/day. Blood cell counts and blood chemistry were followed after the start of MZR.
【Results】In all groups, the levels of transaminases and biliary enzymes tended to decrease at 3, 6 and 12 months after the start of MZR treatment; group S also showed a significant decrease in the total bilirubin (TB) level (9.2 mg to 0.9 mg). Moreover, the dosages of steroids and the concentrations of Tac were significantly decreased in all groups, though the dosages of MZR rarely changed throughout the same period. The proportion of patients in each group whose alanine aminotransferase (ALT) and TB levels were within 1.5 times the facility-specific standard increased to 50%, from 0% for ALT, and to 75―100%, from 14.3―66.7% for TB. Adverse effects of MZR treatment were observed in 12 patients (40%), including 5 for whom withdrawal of MZR became necessary because of its adverse effects.
【Conclusion】MZR is a drug that can be used for patients with severe and treatment-resistant rejection, accompanied by steroid-and Tac-sparing effects. Its adverse effects are relatively mild.
