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. 2015 Jul-Sep;28(3):366-373.

Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation

Fernando H Calmet  1 , Andres J Yarur  1 , Geetha Pukazhendhi  2 , Jawad Ahmad  3 , Kalyan R Bhamidimarri  4
Affiliations

Endoscopic and histological features of mycophenolate mofetil colitis in patients after solid organ transplantation

Fernando H Calmet et al. Ann Gastroenterol. 2015 Jul-Sep.

Abstract

Background: Mycophenolate mofetil (MMF) is an immunosuppressive agent commonly used after organ transplantation. Gastrointestinal side effects occur in approximately 45% of patients. The spectrum of histologic features associated with MMF colitis has been well described, but data on the endoscopic features is lacking. The aim of the study was to describe the endoscopic features of MMF colitis in solid organ transplant recipients (SOTRs) as well as the frequency of histologic features and identify associated risk factors.

Methods: A retrospective review of all SOTRs taking MMF and who underwent colonoscopy between 2000 and 2010 was performed. 36 cases of MMF colitis were identified and 361 patients served as controls. Descriptive statistics and data analysis looking for associated risk factors were performed.

Results: Among SOTRs taking MMF who underwent colonoscopy, MMF colitis was diagnosed in 9%. Endoscopic findings ranged from erythema (33%) to erosions/ulcers (19%). 47% of patients had a normal colonoscopy and everyone had rectal sparing. Histological findings included acute colitis-like findings (50%), inflammatory bowel disease-like characteristics (36%), ischemia-like findings (5.6%), and graft-versus-host disease-like features (8.3%). Diarrhea occurred in 83%. Kidney transplantation was associated with a higher risk of MMF colitis (OR 5.8 [2.86-11.86], P<0.0001) whereas liver transplantation was associated with a lower risk (OR 0.06 [0.03-0.16], P<0.0001).

Conclusion: MMF colitis is fairly prevalent in SOTRs taking MMF who undergo colonoscopy. Diarrhea is the most common reason for colonoscopy referral (83%) and up to 47% of patients have normal colonoscopy, suggesting the need for routine biopsies to help confirm the diagnosis.

Keywords: Colitis; colonoscopy; mycophenolate mofetil; mycophenolic acid; transplant recipients.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
Colonoscopy findings in a patient with MMF colitis. (A) A 1 cm serpiginous, slightly depressed ulcer with a white exudate at the base, flat margins, and no evidence of bleeding can be seen at 3 o’ clock. The mucosa is irregular, erythematous, has no vascular pattern, and has multiple petechial lesions. (B) A 1.5 cm ulcer with a whitish exudate at the base, raised borders, and no evidence of bleeding can be seen covering most of the image
Figure 2
Figure 2
Colonic biopsies in MMF colitis. (A) IBD-like pattern with diffuse lymphoplasmacytic infiltrate, withered crypts, and apoptotic bodies. (B) Ulcer biopsy with loss of the mucosa layer and dense underlying lymphoplasmacytic infiltrate
See this image and copyright information in PMC

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