Does mycophenolate mofetil increase the risk of cytomegalovirus infection in solid organ transplant recipients?: A mini-review

Abstract

Mycophenolate mofetil (MMF) is currently used for prophylaxis of acute rejection in solid organ transplantation. There have been diverging reports regarding an association between MMF and the risk of cytomegalovirus (CMV) infection. We reviewed the main published studies in an attempt to clarify the association between the use of MMF and the risk, frequency and severity of CMV infections. In a search of the Medline database with the terms "mycophenolate" and "cytomegalovir*", 42 articles were found to be relevant; among these, 29 articles were thoroughly analyzed. The first studies on MMF in renal transplantation already showed a tendency towards an association between this drug and the occurrence of CMV disease. Further studies were designed specifically to study this association; with the conclusion that an immunosuppressive regimen containing MMF increases the likelihood of CMV disease. Most studies were performed with kidney transplant recipients. We conclude that the use of MMF apparently increases the incidence of CMV disease in renal transplant patients; however, further studies are needed to confirm this association.

Pre-emptive intravenous ganciclovir versus valganciclovir prophylaxis for de novo cytomegalovirus-seropositive kidney-transplant recipients

“…It has been shown that kidney-transplant recipients receiving mycophenolate mofetil (MMF)-therapy, compared to azathioprine therapy, have an increased risk for HCMV disease [20]. Song et al have written a mini-review on this topic [21]. Similarly, we showed that maintenance immunosuppression with ciclosporine A associated with mycophenolic acid (vs tacrolimus/mycophenolic acid) is an independent risk factor for HCMV infection and/or disease.…”

Successful treatment of severe crescentic lupus nephritis by multi-target therapy using tacrolimus and mycophenolate mofetil

“…In general, MMF is reported to be associated with a lower risk of infections and leukopenia than IVCY [12,13]. However, some researchers have pointed out that MMF possibly increases the risk of CMV infection in patients who have undergone renal transplantation [14]. Indeed, in a previous study conducted by us, 6 out of 16 (37.5 %) LN patients developed the complication of CMV viremia during the early phase of multi-target therapy [7].…”

Mycophenolate Mofetil-Related Enterocolitis and Weight Loss: A Pediatric Case Series

“…In particular, other explanations for symptoms such as infection, graft-versus-host disease, inflammatory bowel disease, celiac disease, or other enteropathies should be explored. Solid organ transplant patients taking MMF are at high risk for infections causing diarrhea, particularly infections such as CMV that may benefit from reduced immunosuppression, and an unrecognized infection may explain the improvement in symptoms with drug withdrawal [8, 11, 15]. Despite the high rate of infections associated with diarrhea and MMF, MMF-related enterocolitis appears to be a separate entity described in up to 40% of patients taking MMF without infection or other explanation for their symptoms [11].…”