Document Detail

B-cell dysfunction and depletion using mycophenolate mofetil in a pediatric combined liver and kidney graft recipient.
MedLine Citation:
PMID:  11260491     Owner:  NLM     Status:  MEDLINE    
The use of mycophenolate mofetil (MMF) in combination with cyclosporin A (CsA) and steroids is well established after kidney transplantation (Tx) in children. A 9-yr-old girl with primary hyperoxaluria type 1 and systemic oxalosis underwent a combined kidney and liver Tx at our institution. The post-operative immunosuppression consisted of CsA, prednisolone, and MMF. Four weeks post-transplant the girl suffered from a severe urinary tract infection caused by Pseudomonas aeruginosa, when the serum immunoglobulin G (IgG) concentration was found to be critically low (<1.53 g/L). Additionally, there was an isolated B-cell depletion (240/microL) at that time. In the following course, the B-cell count was significantly diminished until the MMF was stopped 13 weeks post-transplant. As a result of the very low serum IgG concentration, intravenous immunoglobulin (IVIG) substitution was necessary. There was no significant loss of immunoglobulins in the ascites and urine and no other medication with possible side-effects on B cells was given. We suggest that MMF can lead to suppressed IgG production by B cells and can cause a defective differentiation into mature B cells. In vitro studies demonstrated these effects of MMF on B cells, but no in vivo cases of this phenomenon have been reported. B-cell counts and serum IgG concentrations returned to normal values after discontinuing the MMF. As we can assume that the observed B-cell dysfunction and depletion were MMF related, we suggest that serum IgG concentrations should be monitored when MMF is used after solid-organ Tx.
R Ganschow; M Lyons; M J Kemper; M Burdelski
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pediatric transplantation     Volume:  5     ISSN:  1397-3142     ISO Abbreviation:  Pediatr Transplant     Publication Date:  2001 Feb 
Date Detail:
Created Date:  2001-03-30     Completed Date:  2001-05-10     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  9802574     Medline TA:  Pediatr Transplant     Country:  Denmark    
Other Details:
Languages:  eng     Pagination:  60-3     Citation Subset:  IM    
Department of Pediatrics, University of Hamburg, Germany.
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MeSH Terms
B-Lymphocytes / drug effects*,  immunology
Cyclosporine / adverse effects
Graft Rejection / drug therapy
Immunocompromised Host
Immunosuppressive Agents / adverse effects*
Kidney Transplantation / immunology*
Liver Transplantation / immunology*
Mycophenolic Acid / adverse effects*,  analogs & derivatives*
Prednisolone / adverse effects
Pseudomonas aeruginosa
Urinary Tract Infections / etiology
Reg. No./Substance:
0/Immunosuppressive Agents; 24280-93-1/Mycophenolic Acid; 50-24-8/Prednisolone; 59865-13-3/Cyclosporine; 9242ECW6R0/mycophenolate mofetil

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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