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Crohn's-like changes in the colon due to mycophenolate?
I J Dalle1, B D Maes, K P Geboes
1University Hospitals Leuven, Leuven, Belgium. ignace.dalle@planetinternet.be
Summary
Mycophenolate mofetil (MMF) can cause chronic diarrhea in kidney transplant patients. While often infectious, MMF is linked to Crohn's disease-like changes in the colon, not affecting E-cadherin or proliferation.
Area of Science:
- Gastroenterology
- Nephrology
- Transplant Medicine
Background:
- Mycophenolate mofetil (MMF) is a key immunosuppressant for preventing kidney transplant rejection.
- A subset of patients on MMF develop chronic diarrhea of unknown etiology.
- Investigating the colonic mucosal impact of MMF is crucial for understanding transplant patient complications.
Purpose of the Study:
- To determine the effect of Mycophenolate mofetil (MMF) on the colonic mucosa in kidney transplant recipients with chronic diarrhea.
- To differentiate MMF-induced changes from other causes of diarrhea in this patient population.
Main Methods:
- Analysis of colonic mucosal biopsies from 24 kidney transplant patients on MMF with chronic diarrhea.
- Utilized routine staining and immunohistochemistry for Ki67 and E-cadherin.
- Compared findings with a control group of 19 kidney transplant patients not on MMF.
Main Results:
- Infectious causes identified in 11 patients.
- 19/24 MMF patients exhibited Crohn's disease-like histological alterations: crypt distortion, increased mucin, mild inflammation, and dilated crypts.
- Ki67 and E-cadherin staining showed no significant differences between MMF and control groups.
Conclusions:
- Diarrhea post-MMF is often infectious but can be associated with Crohn's-like colonic mucosal changes in some patients.
- MMF does not appear to significantly alter colonic epithelial proliferation (Ki67) or E-cadherin expression.
- These findings aid in diagnosing and managing chronic diarrhea in kidney transplant patients on MMF.