Related Experiment Video

Updated: Jun 27, 2026

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS
08:38

Quantification of the Immunosuppressant Tacrolimus on Dried Blood Spots Using LC-MS/MS

Published on: November 8, 2015

Progressive multifocal leukoencephalopathy and use of mycophenolate mofetil after kidney transplantation

Robert T Neff1, Frank P Hurst, Edward M Falta

  • 1Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA. robert.neff@.amedd.army.mil

Transplantation
|November 27, 2008
PubMed

Insights

Progressive multifocal leukoencephalopathy (PML) is rare after kidney transplant. This study found no significant association between mycophenolate mofetil (MMF) and PML, though MMF use was high, limiting definitive conclusions.

Area of Science:

  • Nephrology
  • Immunology
  • Infectious Disease

Background:

  • Progressive multifocal leukoencephalopathy (PML) is a rare, serious opportunistic infection.
  • Mycophenolate mofetil (MMF) is an immunosuppressant used in organ transplantation.
  • The potential association between MMF and PML requires further investigation in renal transplant recipients.

Purpose of the Study:

  • To determine the incidence, prognosis, and clinical features of PML in kidney transplant recipients.
  • To investigate the association between MMF use and PML after kidney transplantation.
  • To identify risk factors for PML in this patient population.

Main Methods:

  • Retrospective cohort study utilizing the United States Renal Data System (USRDS) kidney transplant files.
  • Inclusion of 32,757 renal transplant recipients transplanted between January 1, 2000, and July 31, 2004.
  • Follow-up data collected through December 31, 2004, to assess PML incidence and outcomes.

Main Results:

  • The incidence density of PML in MMF users was 14.4 cases/100,000 person-years at risk, compared to 0 in non-MMF users (P=0.11).
  • Significant factors associated with PML included BK virus infection, pretransplant transfusion, high panel reactive antibody (PRA >20%), and early use of antirejection medications.
  • PML was found to be rare in the overall renal transplant population studied.

Conclusions:

  • PML is an uncommon complication in renal transplant recipients.
  • While a direct significant association between MMF and PML was not established in this cohort, the high MMF usage necessitates cautious interpretation.
  • BK virus infection and heightened immune sensitization are significant risk factors for PML post-kidney transplant.

Related Concept Videos

Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
Cytomegalovirus Disease01:27

Cytomegalovirus Disease

Cytomegalovirus (CMV) disease is caused by human cytomegalovirus, a double-stranded DNA virus of the Herpesviridae family. While primary CMV infection is often asymptomatic in immunocompetent individuals, the virus can cause severe disease in neonates and immunocompromised patients. CMV is the most common cause of congenital viral infection in the United States, and a major pathogen in solid organ and hematopoietic stem cell transplant recipients.CMV is transmitted via bodily fluids, sexual...
Kidney Transplant III: Nursing Management01:16

Kidney Transplant III: Nursing Management

Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
Encephalitis l: Introduction01:19

Encephalitis l: Introduction

Encephalitis is inflammation of the brain parenchyma, most often due to infections or autoimmune processes. It presents with neuropsychiatric features such as fever, altered mental status, behavioral changes, cognitive dysfunction, seizures, focal deficits, and sometimes autonomic instability. In some cases, the meninges are also involved, resulting in meningoencephalitis.Infectious CausesInfectious encephalitis is most commonly viral but can also result from bacterial, fungal, or parasitic...
Hepatic Encephalopathy01:29

Hepatic Encephalopathy

DefinitionHepatic encephalopathy is a reversible neurologic syndrome that results from advanced liver dysfunction or portosystemic shunting. It leads to disturbances in cognition, behavior, and motor function due to the brain’s exposure to gut-derived toxins that the liver fails to detoxify.EtiologyThis condition develops either in the setting of acute fulminant hepatitis or progressively during chronic liver disease, such as cirrhosis and portal hypertension. Portosystemic shunting—including...