Mycophenolate Mofetil–Related Gastrointestinal Mucosal Injury in Multivisceral Transplantation

Delacruz, Victor; Weppler, Deborah; Island, Eddie; Gonzalez, M.; Tryphonopoulos, Panagiotis; Moon, Jang; Smith, Leslie; Tzakis, Andreas G.; Ruiz, Phillip

doi:10.1016/j.transproceed.2009.12.027

Cited by 18 publications

(13 citation statements)

References 9 publications

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“…Diarrhoea is the most commonly reported adverse effect, reported in up to 36.1% of patients 1. Diarrhoea is not an entirely inconsequential side effect, and may necessitate physician-directed reduced dosing or drug cessation, lead to non-compliance, and in severe cases result in a wasting illness 5. Dose adjustments are required in approximately 60% of patients treated with MMF due to side effects, such as leucopenia and diarrhoea 6.…”

Section: Discussionmentioning

confidence: 99%

Pointers and pitfalls of mycophenolate-associated colitis

et al. 2012

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Although a wide spectrum of changes may be seen in MMF-associated colitis, important microscopic clues include a mixed pattern of injury (typically a combination of crypt apoptosis, isolated crypt damage and architectural distortion), and possible proximal accentuation of pathologic changes. The need for clinical correlation and follow-up is emphasised by the occurrence of dual pathology in patients treated with MMF.

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Section: Discussionmentioning

confidence: 99%

Pointers and pitfalls of mycophenolate-associated colitis

et al. 2012

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“…Among transplant patients, translocation of colonizing microbes through the mucosa of the digestive tract is facilitated as the mucosal barrier is injured by medical or surgical interventions . In our study, we aimed to examine the colonization burden in the setting of solid organ transplantation, and to evaluate the link between colonization and infection.…”

Section: Introductionmentioning

confidence: 99%

Colonization with extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae in solid organ transplantation: A meta‐analysis and review

Alevizakos

Kallias

Flokas

et al. 2017

Transplant Infectious Dis

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“…Gastrointestinal toxicity associated with the immunosuppressive agent mycophenolate mofetil may histologically show graft‐versus‐host disease (GVHD)‐like changes with increased apoptotic bodies in the small bowel and colon . This clearly overlaps histologically with small bowel ACR, and while differentiating between these two entities may be challenging, it is very clinically important and requires correlation with medication history.…”

Section: Discussionmentioning

confidence: 99%

“…The differences in ACR rates may be due to differences in immunosuppression regimens, biopsy surveillance protocols, or other institution- Gastrointestinal toxicity associated with the immunosuppressive agent mycophenolate mofetil may histologically show graft-versus-host disease (GVHD)-like changes with increased apoptotic bodies in the small bowel and colon. [5][6][7] This clearly overlaps histologically with small bowel ACR, and while differentiating between these two entities may be challenging, it is very clinically important and requires correlation with medication history. In our study, we found that evaluation of native bowel biopsies appeared to be helpful in allowing the pathologist to favor either ACR or medication effect in 24% of cases from which native bowel biopsies were simultaneously examined.…”

Section: Discussionmentioning

confidence: 99%

Allograft biopsy findings in patients with small bowel transplantation

Koo

Dawson

Dry

et al. 2016

Clinical Transplantation

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In this study, we sought to determine the incidence of post-transplant complications including acute cellular rejection (ACR), infection, and post-transplant lymphoproliferative disease (PTLD) in mucosal allograft biopsies in patients with small bowel transplant at our institution. We retrospectively reviewed pathology reports from 5675 small bowel allograft biopsies from 99 patients and analyzed the following: indications for biopsy, frequency and grade of ACR, the presence of infectious agents, results of workup for potential PTLD, results of C4d immunohistochemistry (IHC), features of chronic mucosal injury, and findings in concurrent native bowel biopsies. Findings from 42 allograft resection specimens were also correlated with prior biopsy findings. Indeterminate, mild, moderate, and severe ACR were seen in 276 (4.9%), 409 (7.2%), 100 (1.8%), and 207 (3.6%) of biopsies, respectively. Although ACR may show histologic overlap with mycophenolate mofetil toxicity, we found the analysis of concurrent native bowel biopsies to be helpful in this distinction. Adenovirus was the most common infectious agent seen (11%), and we routinely performed adenovirus IHC on biopsies. Eighteen patients (18%) developed PTLD, 83% of which were EBV associated, but only 28% of PTLD cases were diagnosed on mucosal allograft biopsies. C4d IHC did not correlate with the presence of donor-specific antibodies in limited cases.

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Mycophenolate Mofetil–Related Gastrointestinal Mucosal Injury in Multivisceral Transplantation

Cited by 18 publications

References 9 publications

Pointers and pitfalls of mycophenolate-associated colitis

Pointers and pitfalls of mycophenolate-associated colitis

Colonization with extended‐spectrum beta‐lactamase‐producing Enterobacteriaceae in solid organ transplantation: A meta‐analysis and review

Allograft biopsy findings in patients with small bowel transplantation

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