Improvement of gastrointestinal symptoms after conversion from mycophenolate mofetil to enteric‐coated mycophenolate sodium in liver transplant patients

Toledo AH, Hendrix L, Buchholz V, Fisher E, Newton K, Smith C, Gerber DA. Improvement of gastrointestinal symptoms after conversion from mycophenolate mofetil to enteric‐coated mycophenolate sodium in liver transplant patients. Clin Transplant 2012: 26: 156–163. © 2011 John Wiley & Sons A/S. Abstract: As many as 50% of liver transplant patients suffer gastrointestinal (GI) disturbances post‐transplant. Conversion from mycophenolate mofetil (MMF) to mycophenolate sodium (EC‐MPS) alleviates GI symptom burden in renal transplant recipients. We employed a validated patient and physician‐reported assessment to evaluate the impact of conversion to EC‐MPS in liver transplant patients. This is a prospective, longitudinal, single‐center, open‐label pilot study. Thirty‐one MMF‐treated liver transplant patients with GI symptoms were converted to equimolar EC‐MPS. Gastrointestinal Symptom Rating Scale (GSRS), GI Quality of Life, SF‐12v2 and physician‐reported assessments were used to evaluate GI symptom burden and severity. A significant improvement in overall GSRS score was noted from baseline (2.57; 95% CI 2.12–3.10) to one month (1.90; 1.68–2.12; p = 0.0007) and three months (1.82; 1.60–2.04; p = 0.0002) post‐conversion with significant reductions in all subgroups except Reflux. The overall Gastrointestinal Quality of Life Index (GIQLI) score also showed significant increase in health‐related quality of life between one month (90.89; 84.04–97.75) and three months (100.04; 94.57–105.51; p = 0.0009), with all subgroups except social functioning (p = 0.0861) and medical treatment (p = 0.3156) demonstrating significant improvements. This pilot study demonstrates improvement in GI symptom burden when converting from equimolar doses of MMF to EC‐MPS. This benefit persisted for three months without evidence of rejection.