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Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation
Fernando H Calmet1, Andres J Yarur1, Geetha Pukazhendhi2
1Division of Gastroenterology, Department of Medicine, University of Miami Miller School of Medicine (Fernando H. Calmet, Andres J. Yarur), USA.
Background:
Mycophenolate mofetil (MMF) is an immunosuppressive agent commonly used after organ transplantation. Gastrointestinal side effects occur in approximately 45% of patients. The spectrum of histologic features associated with MMF colitis has been well described, but data on the endoscopic features is lacking. The aim of the study was to describe the endoscopic features of MMF colitis in solid organ transplant recipients (SOTRs) as well as the frequency of histologic features and identify associated risk factors.
Methods:
A retrospective review of all SOTRs taking MMF and who underwent colonoscopy between 2000 and 2010 was performed. 36 cases of MMF colitis were identified and 361 patients served as controls. Descriptive statistics and data analysis looking for associated risk factors were performed.
Results:
Among SOTRs taking MMF who underwent colonoscopy, MMF colitis was diagnosed in 9%. Endoscopic findings ranged from erythema (33%) to erosions/ulcers (19%). 47% of patients had a normal colonoscopy and everyone had rectal sparing. Histological findings included acute colitis-like findings (50%), inflammatory bowel disease-like characteristics (36%), ischemia-like findings (5.6%), and graft-versus-host disease-like features (8.3%). Diarrhea occurred in 83%. Kidney transplantation was associated with a higher risk of MMF colitis (OR 5.8 [2.86-11.86], P<0.0001) whereas liver transplantation was associated with a lower risk (OR 0.06 [0.03-0.16], P<0.0001).
Conclusion:
MMF colitis is fairly prevalent in SOTRs taking MMF who undergo colonoscopy. Diarrhea is the most common reason for colonoscopy referral (83%) and up to 47% of patients have normal colonoscopy, suggesting the need for routine biopsies to help confirm the diagnosis.
Insights
Mycophenolate mofetil (MMF) colitis affects 9% of solid organ transplant recipients. Endoscopic findings vary, and routine biopsies are recommended due to normal colonoscopies in nearly half of patients.
Area of Science:
- Gastroenterology
- Transplantation Medicine
- Pharmacology
Background:
- Mycophenolate mofetil (MMF) is a key immunosuppressant post-organ transplantation.
- Gastrointestinal side effects impact approximately 45% of patients.
- Endoscopic features of MMF colitis are not well-documented.
Purpose of the Study:
- To characterize the endoscopic findings of MMF colitis in solid organ transplant recipients (SOTRs).
- To determine the frequency of histological features in MMF colitis.
- To identify risk factors associated with MMF colitis.
Main Methods:
- Retrospective review of SOTRs on MMF undergoing colonoscopy (2000-2010).
- 36 MMF colitis cases identified and compared to 361 controls.
- Descriptive statistics and risk factor analysis performed.
Main Results:
- MMF colitis diagnosed in 9% of SOTRs on MMF.
- Endoscopic findings included erythema (33%) and erosions/ulcers (19%).
- 47% of patients had normal colonoscopies; rectal sparing was universal.
- Histology showed acute colitis (50%), IBD-like (36%), ischemia-like (5.6%), and GVHD-like (8.3%) features.
- Diarrhea was the primary symptom (83%).
- Kidney transplant recipients had higher MMF colitis risk (OR 5.8), liver recipients lower risk (OR 0.06).
Conclusions:
- MMF colitis is prevalent in SOTRs on MMF.
- Diarrhea is the most common referral reason, but colonoscopies can be normal in 47% of cases.
- Routine biopsies are crucial for diagnosing MMF colitis.
