title: Mycophenolate mofetil toxicity mimicking acute cellular rejection in a small intestinal transplant.
abstract: Mycophenolate mofetil (MMF) is an important medication used for maintenance immunosuppression in solid organ transplants. A common gastrointestinal (GI) side effect of MMF is enterocolitis, which has been associated with multiple histological features. There is little data in the literature describing the histological effects of MMF in small intestinal transplant (SIT) recipients. We present a case of MMF toxicity in a SIT recipient, with histological changes in the donor ileum mimicking persistent acute cellular rejection (ACR). Concurrent biopsies of the patient's native colon showed similar changes to those from the donor small bowel, suggesting a non-graft specific process, raising suspicion for MMF toxicity. The MMF was discontinued and complete resolution of these changes occurred over three weeks. MMF toxicity should therefore be considered as a differential diagnosis for ACR and graft-versus-host disease in SITs.
authors.affiliation: Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro, Australian Intestinal Transplant Service, Austin Health, Heidelberg, VIC 3084, Australia.
authors.forename: Ross
authors.initials: R
authors.lastname: Apostolov
authors.affiliation: Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro, Australian Intestinal Transplant Service, Austin Health, Heidelberg, VIC 3084, Australia.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Asadi
authors.affiliation: Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro, Australian Intestinal Transplant Service, Austin Health, Heidelberg, VIC 3084, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Lokan
authors.affiliation: Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro, Australian Intestinal Transplant Service, Austin Health, Heidelberg, VIC 3084, Australia.
authors.forename: Ning
authors.initials: N
authors.lastname: Kam
authors.affiliation: Ross Apostolov, Khashayar Asadi, Julie Lokan, Ning Kam, Adam Testro, Australian Intestinal Transplant Service, Austin Health, Heidelberg, VIC 3084, Australia.
authors.forename: Adam
authors.initials: A
authors.lastname: Testro
keywords: Acute cellular rejection; Drug toxicity; Immunosuppression; Mycophenolate mofetil; Small intestinal transplantation