Related Experiment Videos
Erosive enterocolitis in mycophenolate mofetil-treated renal-transplant recipients with persistent afebrile diarrhea
Bart D Maes1, Ignace Dalle, Karen Geboes
1Department of Medicine, Division of Nephrology, University Hospital Gasthuisberg, Leuven, Belgium.
Background:
Diarrhea is the most frequently reported adverse event in mycophenolate mofetil (MMF)-treated transplant patients. The aim of this study was to explore the gastrointestinal tract in MMF-treated renal transplant recipients with persistent afebrile diarrhea to characterize its nature and etiology.
Methods:
Renal transplant recipients with persistent afebrile diarrhea (daily fecal output >200 g) were prospectively investigated for infections, morphologic, and functional (gastrointestinal motility and intestinal absorptive capacity) integrity of the gastrointestinal tract; 26 patients met the inclusion criteria.
Results:
All but one patient had an erosive enterocolitis. Seventy percent of the patients had malabsorption of nutrients, contributing to the diarrhea. In +/-60%, an infectious origin was demonstrated and successfully treated with antimicrobial agents without changes in immunosuppressive regimen. In +/-40%, no infection occurred, but a Crohn's disease-like pattern of inflammation was noted. These patients also had a less pronounced bile-acid malabsorption but a significant faster colonic transit time, correlating with the trough level of mycophenolic acid (MPA). Cessation of MMF, however, was associated with allograft rejection in one third of these patients.
Conclusions:
Persistent afebrile diarrhea in renal transplant recipients is characterized by erosive enterocolitis, which is of infectious origin in +/-60%. In +/-40%, a Crohn's disease-like (entero-)colitis was present. Because reduction or cessation of MMF was the only effective therapy, MPA or one of its metabolites may be suggested as a possible cause. However, reduction or cessation of MMF was associated with an increased risk for rejection.
Insights
Persistent diarrhea in kidney transplant patients on mycophenolate mofetil (MMF) is often erosive enterocolitis. Infectious causes are common, but some cases resemble Crohn's disease, with MMF potentially implicated.
Area of Science:
- Nephrology
- Gastroenterology
- Pharmacology
Background:
- Diarrhea is a frequent adverse event in patients receiving mycophenolate mofetil (MMF) post-transplant.
- Investigating persistent diarrhea in renal transplant recipients treated with MMF is crucial for understanding its etiology.
Purpose of the Study:
- To characterize the nature and causes of persistent afebrile diarrhea in renal transplant recipients treated with MMF.
- To explore gastrointestinal tract integrity, including morphology, function, and infectious agents.
Main Methods:
- Prospective investigation of 26 renal transplant recipients with persistent afebrile diarrhea (>200 g/day stool output).
- Assessment included infectious workup, morphologic examination, gastrointestinal motility, and intestinal absorptive capacity.
- Correlated findings with mycophenolic acid (MPA) trough levels and MMF cessation outcomes.
Main Results:
- Erosive enterocolitis was observed in nearly all patients.
- Malabsorption contributed to diarrhea in 70% of patients.
- Infectious origins were identified and treated successfully in ~60%; ~40% showed Crohn's disease-like inflammation with faster colonic transit correlated with MPA levels.
Conclusions:
- Persistent diarrhea in MMF-treated renal transplant patients involves erosive enterocolitis, often infectious (~60%) or Crohn's-like (~40%).
- Mycophenolic acid (MPA) or its metabolites may cause diarrhea, but MMF reduction/cessation risks allograft rejection.