Related Experiment Video
Updated: Feb 17, 2026
Mouse Model for Pancreas Transplantation Using a Modified Cuff Technique
Published on: December 16, 2017
Intractable ascites associated with mycophenolate in a simultaneous kidney-pancreas transplant patient: a case report
Nina T Weber1, Ali Sigaroudi2, Alexander Ritter1
1Clinic of Nephrology, Departments of Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
Background:
Mycophenolic acid (MPA), either given as an ester pro-drug or as an enteric-coated sodium salt, is the most commonly prescribed anti-proliferative immunosuppressive agent used following organ transplantation and widely applied in immune-mediated diseases. Clinicians are well aware of common adverse reactions related to MPA treatment, in particular diarrhea, leukopenia and infections. Here we report a case of severe, persistent ascites associated with MPA treatment. The otherwise unexplained and intractable ascites, requiring repeated paracenteses for more than 8 months, rapidly ceased with stopping the MPA treatment. To our knowledge this is the first case of severe ascites associated with MPA treatment reported in the scientific literature.
Case Presentation:
A 45-year old female with type 1 diabetes mellitus received a simultaneous kidney-pancreas transplant. The surgery was uneventful. However, post-operatively she developed severe transudative ascites requiring in total more than 40 paracenteses treatments draining in the average 2.8 l of ascites fluid. The ascites formation persisted despite exclusion of a surgical complication, fully functioning kidney and pancreas allografts, lack of any significant proteinuria, normalization of circulating albumin levels, intensive use of diuretics and deliberate attempts to increase the intervals between the paracentesis treatments. Various differential diagnoses, including infectious, hepatic, vascular and cardiac causes were ruled out. Nine months after surgery enteric-coated mycophenolate sodium was switched to azathioprine after which ascites completely resolved. When mycophenolate was recommenced abdominal fullness and weight gain reoccurred. The patient had to be switched to long-term azathioprine treatment. More than 1 year post-conversion the patient remains free of ascites.
Conclusion:
MPA is the most widely used antimetabolite immunosuppressive agent. We suggest to consider MPA treatment in the differential diagnosis of severe and unexplained ascites in transplant and non-transplant patients.
Insights
Mycophenolic acid (MPA) can cause severe ascites, a rare side effect. This case report highlights the need to consider MPA in unexplained ascites for transplant and non-transplant patients.
Area of Science:
- Immunosuppressive therapy
- Transplantation medicine
- Gastroenterology
Background:
- Mycophenolic acid (MPA) is a widely used immunosuppressant for organ transplant recipients and autoimmune diseases.
- Common MPA side effects include diarrhea, leukopenia, and infections.
- Severe, unexplained ascites is not a commonly recognized adverse reaction to MPA.
Observation:
- A kidney-pancreas transplant recipient developed severe, persistent transudative ascites.
- Ascites required over 40 paracenteses for fluid drainage.
- The ascites resolved after switching from MPA to azathioprine and recurred upon MPA reintroduction.
Findings:
- The patient's ascites was refractory to diuretics and other standard treatments.
- Exclusion of surgical, infectious, hepatic, vascular, and cardiac causes confirmed the ascites' idiopathic nature.
- Cessation of MPA led to complete resolution of ascites, indicating a direct causal link.
Implications:
- This case suggests Mycophenolic acid (MPA) should be considered in the differential diagnosis of severe, unexplained ascites.
- Clinicians should monitor for ascites in patients on MPA, particularly those with a history of transplantation or immune-mediated diseases.
- Further investigation into the mechanism of MPA-induced ascites may be warranted.
Related Concept Videos
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management
01:28Kidney Transplant I: Introduction
01:29Chronic Pancreatitis II: Collaborative Care
Assessment: