Oral ulcers associated with mycophenolate mofetil use in a renal transplant recipient.

PURPOSE: A case study of mycophenolate mofetil-induced oral ulcers in a renal transplant patient is reported. SUMMARY: A 23-year-old Hispanic man who received a renal transplant from a living relative secondary to end-stage renal disease due to focal segmental glomerulosclerosis arrived at an outpatient clinic with gum swelling and pain. He had been on a maintenance immunosuppressive regimen consisting of cyclosporine 150 mg twice daily, mycophenolate mofetil 1 g twice daily, and prednisone 12.5 mg daily for approximately four months. Routine laboratory tests revealed an elevated serum creatinine concentration (2.2 mg/ dL) and a decreased white blood cell count (2.3 × 10(3)/µL). All other laboratory test values were within normal limits. Initially, cyclosporine-induced gingival hyperplasia was suspected. However, despite reduction of the cyclosporine dosage, the gum pain and swelling did not improve, and the patient began to complain of odynophagia and worsening of symptoms. On physical examination, scattered ulcerations on the gums and lips were noted. The diagnosis of oral ulcerations secondary to mycophenolate mofetil therapy was suspected when other etiologies, such as hematologic disorders, malignancies, and viral infections, were eliminated. Mycophenolate mofetil was discontinued. One week later, the patient's ulcers had regressed and odynophagia improved, as did his renal function and leukopenia. Mycophenolate mofetil was not restarted, and the patient reported complete resolution of symptoms six weeks after discontinuation of mycophenolate mofetil. CONCLUSION: After five months of therapy, a 23-year-old renal transplant recipient developed mycophenolate mofetil toxicity manifested as oral ulcers. Discontinuation of therapy resulted in rapid resolution of oral ulcers.

The influence of organ acceptance criteria on long-term graft survival: outcomes of a kidney transplant program.

BACKGROUND: In an effort to improve our transplant program's dead-donor kidney acceptance criteria, we compared 2 different consecutive time periods in our transplant program. Period I, in which the program used more-restrictive criteria in accepting dead-donor kidneys for our patients, and period II, when the program used less-restrictive criteria for the dead-donor kidneys that were accepted. The less-restrictive criteria resulted in an increase in the number of renal transplants performed. METHODS: A retrospective database analysis was performed of all organ-donor offers to a single kidney transplant program from July 1, 2004, to September 30, 2006 (period I = July 1, 2004, through July 10, 2005, and period II = July 11, 2005 through September 30, 2006). Kidney acceptance rates were compared between 2 consecutive time periods during which the program used different organ acceptance criteria. Data analysis included a comparison of donor characteristics, reason for organ refusal, creatinine clearance, and graft survival. Graft survival was obtained for both kidneys associated with each offer, even if 1 or both of the organs were transplanted at a different center. RESULTS: Donor age and kidney quality were the most common reasons for refusal during both transplant periods. The organ acceptance rate improved markedly during period II. There was a marked increase in the number of kidney transplants performed during a 12-month period when comparing the 2 periods: 16 transplants during period I versus 46 transplants during period II. Graft survival was not significantly different between the 2 periods. Calculated creatinine clearance, which we used as a marker of organ quality, was statistically lower during period II. CONCLUSIONS: Increased acceptance rate was not associated with statistically significant decreased graft survival. Although an increase in delayed graft function was associated with broader acceptance criteria, this factor did not affect overall graft survival. By increasing our kidney acceptance rate, we were able to successfully transplant more patients.