Mycophenolate mofetil in liver transplantation: A review Alexander Kaltenborn 1,2 AEF, Harald Schrem 2 EF 1 Federal Armed Forces Medical Center Hannover, Hannover ,Germany 2 Department of General, Visceral and Transplantation Surgery, Medizinische Hochschule Hannover, Hannover, Germany Summary Liver transplantation is the only live-saving, curative treatment for various end-stage liver diseases, and it has excellent survival rates. Mycophenolate mofetil is widely used as co-medication for immunosuppression after liver transplantation, especial- ly to allow a sparing effect on calcineurin-inhibitors, thus reducing their numerous adverse effects. It improves both graft and patient survival. The properties of its active metabolite, mycophenolic acid, are diverse: inhibition of de novo purine synthesis and selective lymphocyte inhibition, anti-tumoral, antiviral, anti-angioneoplastic, and vasculoprotective mechanisms are described and summa- rized in this review. The most common adverse effects of mycophenolate mofetil are gastrointestinal complaints such as diarrhea, which often lead to dose-reduction or withdrawal of mycophenolate mofetil. A newer, enteric-coated formulation is available, which is meant to reduce the gastrointestinal adverse effects. Mycophenolate mofetil does not relevantly interact with other common drugs. The question of whether therapeutic drug monitoring allows optimized dosing strategies cannot be satisfyingly answered yet. The optimal partner-immunosuppressant seems to be tacrolimus, especially in low doses. This tutorial review provides an overview of recent studies exploring the role of my- cophenolate mofetil in liver transplantation with regards to its development, mech- anism of action, and actual controversies such as therapeutic drug monitoring or de novo malignancy after transplantation. Key words: mycophenolic acid • de novo malignancy • solid organ transplantation • enteric-coated mycophenolate • Cellcept • Myfortic Full-text PDF: http://www.annalsoftransplantation.com/download/index/idArt/889299 Word count: 4498 Tables: — Figures: 3 References: 98 Author’s address: Harald Schrem, Department of General, Visceral and Transplantation Surgery, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany, e-mail: schrem.harald@mh-hannover.de Received: 2013.04.19 Accepted: 2013.08.10 Published: 2013.12.18 Authors’ Contribution: A Study Design B Data Collection C Statistical Analysis D Data Interpretation E Manuscript Preparation F Literature Search G Funds Collection 685 © Ann Transplant, 2013; 18: 685-696 DOI: 10.12659/AOT.889299 Review Paper WWW.annalsoftransplantation.COM