Mycophenolate mofetil toxicity mimicking acute cellular rejection in a small intestinal transplant.

2017-02-24

Apostolov, Ross

Asadi, Khashayar

Lokan, Julie

Kam, Ning

Testro, Adam G

Acute cellular rejection

Drug toxicity

Immunosuppression

Mycophenolate mofetil

Small intestinal transplantation

Journal Article

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10.5500/wjt.v7.i1.98

Mycophenolate mofetil (MMF) is an important medication used for maintenance immunosuppression in solid organ transplants. A common gastrointestinal (GI) side effect of MMF is enterocolitis, which has been associated with multiple histological features. There is little data in the literature describing the histological effects of MMF in small intestinal transplant (SIT) recipients. We present a case of MMF toxicity in a SIT recipient, with histological changes in the donor ileum mimicking persistent acute cellular rejection (ACR). Concurrent biopsies of the patient's native colon showed similar changes to those from the donor small bowel, suggesting a non-graft specific process, raising suspicion for MMF toxicity. The MMF was discontinued and complete resolution of these changes occurred over three weeks. MMF toxicity should therefore be considered as a differential diagnosis for ACR and graft-versus-host disease in SITs.

link

World Journal of Transplantation 2017; 7(1): 98-102

World Journal of Transplantation

2220-3230