A Multicenter, Randomized, Open-Label Study to Compare the Efficacy and Safety of Tacrolimus and Corticosteroids in Combination With or Without Mycophenolate Mofetil in Liver Transplantation Recipients Infected With Hepatitis B Virus

• Published in: Transplantation proceedings Vol. 55; no. 2; pp. 387 - 395
• Main Authors: Park, Jeong-Ik, Song, Gi-Won, Ryu, Je Ho, Choi, Sang-Tae, Choi, Nam-Gyu, Jung, Bo-Hyun, Chu, Chong Woo, Kim, Keon-Kuk, Jung, Dong-Hwan, Ha, Tae-Yong, Moon, Deok-Bog, Yang, Kwangho, Shin, Min-Ho, Chung, Yong-Kyu, Hwang, Shin, Yoon, Young-In, Lee, Sung-Gyu
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2023
• Subjects: Adrenal Cortex Hormones; Calcineurin Inhibitors - adverse effects; Drug Therapy, Combination; Graft Rejection - prevention & control; Hepatitis B virus; Humans; Immunosuppressive Agents - adverse effects; Liver Transplantation - adverse effects; Living Donors; Mycophenolic Acid - adverse effects; Tacrolimus - adverse effects
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2023.01.013

•Tacrolimus and corticosteroid combined with or without mycophenolate mofetil were evaluated.•Biopsy proven acute cellular rejection (Risk Analysis Index score ≥4) incidence was 3.4% in the full-analysis set study group (not in the control group).•Biopsy proven acute cellular rejection, hepatitis B virus recurrence, mortality, or graft failure were not overserved in the per-protocol set.•No significant differences in serious adverse events between the study and control groups were found.•The triple-drug regimen is safe and effective in living donor liver transplantation patients with hepatitis B virus. Mycophenolate mofetil exhibits pharmacologic mechanisms different from calcineurin inhibitors. Therefore, the dose of calcineurin inhibitors can be reduced along with side effects for effective immunosuppression. We aimed to evaluate the efficacy and safety of tacrolimus and corticosteroid in combination with or without mycophenolate mofetil in living donor liver transplantation (LDLT) recipients infected with hepatitis B virus (HBV). A randomized, open-label, comparative, multicenter, phase IV study was conducted with 119 patients from January 2014 to September 2017. In the full analysis set population, 58 and 59 patients were included in the study group (triple-drug regimen: TacroBell + My-rept + corticosteroid) and the control group (dual-drug regimen: TacroBell + corticosteroid), respectively. In the per protocol set population, 49 and 42 patients were included in the study and control groups, respectively. In the full analysis set population, the incidence of biopsy-proven acute cellular rejection (rejection activity index score ≥4) was 3.4% in the study group; however, this finding was not observed in the control group (P = .468). Hepatitis B virus recurrence was observed in one patient in the control group. No cases of biopsy-proven acute cellular rejection and HBV recurrence were observed in the per protocol set population. The incidences of serious adverse events were 25.9% and 18.0% in the study and control groups, respectively; however, the difference between the groups was not statistically significant (P = .376). Although the study involved a small number of patients, the triple-drug regimen can be considered safe and effective for immunosuppression after living donor liver transplantation in patients infected with HBV.