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Mycophenolate mofetil toxicity mimicking acute cellular rejection in a small intestinal transplant

Ross Apostolov1, Khashayar Asadi1, Julie Lokan1

  • 1Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro, Australian Intestinal Transplant Service, Austin Health, Heidelberg, VIC 3084, Australia.

World Journal of Transplantation
|March 11, 2017
PubMed

Insights

Mycophenolate mofetil (MMF) can cause gastrointestinal issues in small intestinal transplant (SIT) recipients. Histological changes mimicking rejection were resolved by discontinuing MMF, suggesting MMF toxicity as a differential diagnosis.

Area of Science:

  • Gastroenterology
  • Transplant Surgery
  • Immunosuppression

Background:

  • Mycophenolate mofetil (MMF) is a key immunosuppressant in solid organ transplantation.
  • Gastrointestinal (GI) side effects, including enterocolitis, are known complications of MMF.
  • Limited data exists on MMF's histological impact in small intestinal transplant (SIT) recipients.

Observation:

  • A SIT recipient on MMF developed histological changes in the donor ileum.
  • These changes mimicked acute cellular rejection (ACR).
  • Similar histological alterations were observed in the patient's native colon, indicating a systemic effect.

Findings:

  • The observed histological changes were attributed to MMF toxicity.
  • Discontinuation of MMF led to complete resolution of these changes within three weeks.
  • The findings suggest MMF toxicity can present with features resembling ACR and graft-versus-host disease (GVHD).

Implications:

  • MMF toxicity should be considered in the differential diagnosis of unexplained histological changes in SIT recipients.
  • This case highlights the importance of recognizing non-graft-specific MMF toxicity.
  • Awareness of these potential MMF-induced histological changes can guide clinical management and prevent misdiagnosis of rejection.
Keywords:
Acute cellular rejectionDrug toxicityImmunosuppressionMycophenolate mofetilSmall intestinal transplantation

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