Apostolov R, Asadi K, Lokan J, Kam N, Testro A. Mycophenolate mofetil toxicity mimicking acute cellular rejection in a small intestinal transplant. World J Transplant 2017; 7(1): 98-102 [PMID: 28280702 DOI: 10.5500/wjt.v7.i1.98]
Corresponding Author of This Article
Adam Testro, MBBS, FRACP, PhD, Head of Intestinal Rehabilitation and Transplantation, Australian Intestinal Transplant Service, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia. adam.testro@austin.org.au
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Transplant. Feb 24, 2017; 7(1): 98-102 Published online Feb 24, 2017. doi: 10.5500/wjt.v7.i1.98
Mycophenolate mofetil toxicity mimicking acute cellular rejection in a small intestinal transplant
Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro
Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro, Australian Intestinal Transplant Service, Austin Health, Heidelberg, VIC 3084, Australia
Author contributions: Apostolov R, Asadi K, Lokan J and Testro A contributed to writing and revising the paper; all authors contributed to the acquisition and interpretation of data.
Institutional review board statement: This case report was exempt from ethics approval by our Institute’s Ethics Committee.
Informed consent statement: The patient involved in this study gave his informed consent authorising use and disclosure of his anonymised health information and pathology slides.
Conflict-of-interest statement: All authors have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Adam Testro, MBBS, FRACP, PhD, Head of Intestinal Rehabilitation and Transplantation, Australian Intestinal Transplant Service, Austin Health, 145 Studley Road, Heidelberg, VIC 3084, Australia. adam.testro@austin.org.au
Telephone: +61-3-94965353 Fax: +61-3-94963487
Received: November 26, 2016 Peer-review started: November 29, 2016 First decision: December 15, 2016 Revised: December 21, 2016 Accepted: January 11, 2017 Article in press: January 13, 2017 Published online: February 24, 2017 Processing time: 87 Days and 6.1 Hours
Abstract
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.
Core tip: Mycophenolate mofetil (MMF) is a commonly used medication for maintenance immunosuppression in small intestine transplant (SIT) recipients. Enterocolitis is a known side effect of MMF therapy, but there is little literature describing its histological manifestations in SIT recipients. Our case shows that MMF enterocolitis can mimic acute cellular rejection (ACR) and highlights the importance of attempting to biopsy the native gastrointestinal tract in SIT recipients if possible. If the native biopsy is abnormal, drug toxicity should be considered as a differential diagnosis as it may show overlapping features with ACR.
