title: Mycophenolate mofetil increases cytomegalovirus invasive organ disease in renal transplant patients.
abstract: The impact of cytomegalovirus (CMV) infection post-transplantation is in part influenced by the degree of immunosuppression. While mycophenolate mofetil (MMF) does not increase the overall incidence of CMV infection, we have questioned whether or not it increases its severity. Using a case control study design in which 29 renal transplant patients developed CMV disease [17 (59%) of which received azathioprine (AZA) and 12 (41%) received MMF], increases in the frequency of organ involvement with CMV (58 vs. 18%; p = 0.03) and in the number of organs involved with CMV were noted in the MMF versus the AZA group (2.0 vs. 1.0; p = 0.015). These results indicate that the increased immunosuppressive activity of MMF impacts the morbidity of CMV infection, thus warranting the use of effective anti-CMV preventive regimens while patients are treated with MMF.
authors.affiliation: Division of General Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Sarmiento
authors.forename: D H
authors.initials: DH
authors.lastname: Dockrell
authors.forename: T R
authors.initials: TR
authors.lastname: Schwab
authors.forename: S R
authors.initials: SR
authors.lastname: Munn
authors.forename: C V
authors.initials: CV
authors.lastname: Paya
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000009:adverse effects; D016022:Case-Control Studies; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000145:classification / Q000503:physiopathology* / Q000517:prevention & control; D004751:Enteritis / Q000145:classification / Q000821:virology; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D006525:Hepatitis, Viral, Human / Q000145:classification / Q000503:physiopathology; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D015994:Incidence; D016030:Kidney Transplantation / Q000276:immunology; D008297:Male; D009173:Mycophenolic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D011024:Pneumonia, Viral / Q000145:classification / Q000503:physiopathology; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D001379:Azathioprine; D015774:Ganciclovir; D000212:Acyclovir