title: Erosive enterocolitis in mycophenolate mofetil-treated renal-transplant recipients with persistent afebrile diarrhea.
abstract: BACKGROUND
  Diarrhea is the most frequently reported adverse event in mycophenolate mofetil (MMF)-treated transplant patients. The aim of this study was to explore the gastrointestinal tract in MMF-treated renal transplant recipients with persistent afebrile diarrhea to characterize its nature and etiology.
  
  
  METHODS
  Renal transplant recipients with persistent afebrile diarrhea (daily fecal output >200 g) were prospectively investigated for infections, morphologic, and functional (gastrointestinal motility and intestinal absorptive capacity) integrity of the gastrointestinal tract; 26 patients met the inclusion criteria.
  
  
  RESULTS
  All but one patient had an erosive enterocolitis. Seventy percent of the patients had malabsorption of nutrients, contributing to the diarrhea. In +/-60%, an infectious origin was demonstrated and successfully treated with antimicrobial agents without changes in immunosuppressive regimen. In +/-40%, no infection occurred, but a Crohn's disease-like pattern of inflammation was noted. These patients also had a less pronounced bile-acid malabsorption but a significant faster colonic transit time, correlating with the trough level of mycophenolic acid (MPA). Cessation of MMF, however, was associated with allograft rejection in one third of these patients.
  
  
  CONCLUSIONS
  Persistent afebrile diarrhea in renal transplant recipients is characterized by erosive enterocolitis, which is of infectious origin in +/-60%. In +/-40%, a Crohn's disease-like (entero-)colitis was present. Because reduction or cessation of MMF was the only effective therapy, MPA or one of its metabolites may be suggested as a possible cause. However, reduction or cessation of MMF was associated with an increased risk for rejection.
authors.affiliation: Department of Medicine, Division of Nephrology, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Bart D
authors.initials: BD
authors.lastname: Maes
authors.forename: Ignace
authors.initials: I
authors.lastname: Dalle
authors.forename: Karen
authors.initials: K
authors.lastname: Geboes
authors.forename: Michael
authors.initials: M
authors.lastname: Oellerich
authors.forename: Victor W
authors.initials: VW
authors.lastname: Armstrong
authors.forename: Pieter
authors.initials: P
authors.lastname: Evenepoel
authors.forename: Benny
authors.initials: B
authors.lastname: Geypens
authors.forename: Dirk
authors.initials: D
authors.lastname: Kuypers
authors.forename: Maria
authors.initials: M
authors.lastname: Shipkova
authors.forename: Karel
authors.initials: K
authors.lastname: Geboes
authors.forename: Yves F Ch
authors.initials: YF
authors.lastname: Vanrenterghem
mesh_terms: D000328:Adult; D000368:Aged; D002169:Campylobacter Infections; D003967:Diarrhea / Q000139:chemically induced*; D004760:Enterocolitis / Q000139:chemically induced* / Q000382:microbiology / Q000473:pathology* / Q000628:therapy; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D016030:Kidney Transplantation; D008286:Malabsorption Syndromes / Q000139:chemically induced; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000009:adverse effects* / Q000031:analogs & derivatives
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid