What is the role of mycophenolate in immunosuppression therapy in liver transplant patients?

Updated: Dec 31, 2017
  • Author: Lemi Luu, MD, RDMS, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Mycophenolate or mycophenolate with its morpholino ester (MMF) is an antibiotic isolated from Penicillium species that has immunosuppressant properties. Its mechanism of action is similar to that of azathioprine, but it does not cause as much bone marrow suppression. It works by selectively inhibiting purine synthesis, and thus, it is a potent inhibitor of B-cell and T-cell proliferation.

At present, mycophenolate's major role is in treating acute rejection; however, the drug is finding an increasing role in maintenance immunosuppression. It is currently approved in renal transplantation but is increasingly being used in liver and heart transplantation. Mycophenolate is metabolized in the liver to its active form (ie, mycophenolic acid), is subsequently gluconurated in the liver to an inactive form, and is then excreted renally. The oral dosage is 2-4 g/day, with reductions in the face of renal failure. Monitoring of blood levels is generally not required.

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