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GRAFT-VS-HOST DISEASE-LIKE CHANGES IN BIOPSIES FROM PATIENTS ON MYCOPHENOLATE MOFETIL
S Jayakumar, JR Parfitt, DK Driman
London Health Sciences Centre and the University of Western Ontario, London, Ontario
BACKGROUND: Mycophenolate mofetil (MMF) is an immunosuppressive drug used following transplantation. There have been both case reports and studies suggesting that the histology from colonic biopsies in such patients mimic those changes seen with graft-versus-host-disease (GVHD). The goal of this study was to investigate the effect of MMF on gastrointestinal mucosa.
METHODS: The pathology files were searched for biopsies from colonoscopy, flexible sigmoidoscopy or esophagogastroduodenoscopy performed on a transplant recipient between 2002 and March 2007. Medical, pharmacological, transplant, and endoscopic history was obtained by a chart review of the patients’ hospital and transplant clinic charts. The biopsies of all patients were re-examined.
RESULTS: The search yielded 56 biopsies from 52 patients, 30 of which were performed on 28 patients on MMF at the time of the biopsy. The re-review of all study slides is in process, so the results of the correlation between the above changes and MMF dosage and duration are still pending. However, an analysis of the pathology reports done at the time of biopsy show that 14 patients had histological changes consistent with GVHD (dilated and inflamed crypts, apoptosis, and marked reactive changes). One patient had MAI infection in addition to the above changes. Patients with a prior history of IBD were excluded from the analysis. All of the remaining patients for whom we had accessible chart information with histological features of GVHD were on MMF at the time of biopsy. Histological changes of GVHD or IBD were not seen in patients without IBD or on immunosuppression other than MMF.
CONCLUSIONS: Of the 56 biopsies in 52 patients, we found changes suggestive of GVHD in 14 patients. All the patients who exhibited changes on histology that resembled GVHD were on MMF. We conclude that MMF causes histological changes in the colonic mucosa that resemble GVHD.