De Novo Crohn’s Disease in a Renal Transplant Recipient

Halim, M.A.; Said, T; Nair, P; Schmidt, Imre; Hassan, Alaa Ali; Johny, K.V.; Al-Muzairai, I.; Samhan, M; Nampoory, M.R.N.; Al-Mousawi, M

doi:10.1016/j.transproceed.2007.03.045

Cited by 15 publications

(18 citation statements)

References 5 publications

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“…the development of skin or arthritic disease in patients receiving anti-TNF therapy for gut disease [101, 102]. Similarly, “paradoxical” de novo development of IBD, despite aggressive immunosuppression, has been reported in transplant patients [103, 104]. Taken together, these studies further emphasize the notion that, depending on the temporal and spatial parameters, the same molecules may exert pro- or anti-inflammatory properties.…”

Section: Translational Implicationsmentioning

confidence: 82%

New insights into the dichotomous role of innate cytokines in gut homeostasis and inflammation

et al. 2012

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In addition to their well-known role in acute injury and chronic inflammation “innate” cytokines play an important role in health and the maintenance of normal immune homeostasis. This group includes the prototypic cytokines IL-1 and TNF as well as several other members belonging to the IL-1 and TNF family, such as IL-18, IL-33, IL-36-38, and TL1A. The dichotomous role of these cytokines has been best characterized in the intestine where innate cytokines may play both a protective and a pro-inflammatory role, depending upon the immmunological status of the host or the type and phase of the inflammatory process. This new information has produced novel pathogenetic hypotheses that have important translational implications both in regard to the prevention and treatment of chronic intestinal inflammation, including Crohn’s disease and ulcerative colitis, the two major forms of inflammatory bowel disease. This review will discuss and summarize current data regarding the role of IL-1, TNFα, and their family members in regulating gut mucosal homeostasis and chronic intestinal inflammation.

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Section: Translational Implicationsmentioning

confidence: 82%

New insights into the dichotomous role of innate cytokines in gut homeostasis and inflammation

et al. 2012

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“…The final case (case 7) with dual pathology involved a 32-year-old patient with persistent changes and symptoms 1 year after cessation of MMF, raising the possibility of de novo IBD. The development of IBD, post-organ transplant, is uncommon and may be masked, clinically, by immunosuppressive treatment 8 9. In the case of patients receiving MMF, the diagnostic difficulty is further compounded by the IBD-like changes seen on biopsies, and the requirement for continuing immunosuppression.…”

Section: Discussionmentioning

confidence: 99%

Pointers and pitfalls of mycophenolate-associated colitis

et al. 2012

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Although a wide spectrum of changes may be seen in MMF-associated colitis, important microscopic clues include a mixed pattern of injury (typically a combination of crypt apoptosis, isolated crypt damage and architectural distortion), and possible proximal accentuation of pathologic changes. The need for clinical correlation and follow-up is emphasised by the occurrence of dual pathology in patients treated with MMF.

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“…The major risk factors for developing GI problems were the polycystic kidney disease and delayed graft function. The relationships between immunosuppressive therapy and de novo post‐transplant colitis were not straightforward, and among immunosuppressive agents, only MMF was found to promote the development of post‐transplant enterocolitis and Crohn’s disease‐like pattern of colitis [13].…”

Section: Discussionmentioning

confidence: 99%

“…and de novo post-transplant colitis were not straightforward, and among immunosuppressive agents, only MMF was found to promote the development of post-transplant enterocolitis and Crohn's disease-like pattern of colitis [13].…”

Section: Severe Colitis After Prolonged-release Tacrolimusmentioning

confidence: 99%

Two cases of severe de novo colitis in kidney transplant recipients after conversion to prolonged-release tacrolimus

Kurnatowska

Banasiak

Daniel

et al. 2009

Transplant International

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Summary Diarrhea is a frequent complication in patients after solid organ transplantation. We describe two cases of severe new onset colitis in kidney transplant recipients that developed shortly after the introduction of the therapy with prolonged‐release formulation of tacrolimus replacing standard twice daily formulation of tacrolimus in one case and cyclosporine A in the second case. Both patients developed severe, intermittent bloody diarrhea with abdominal pain, weight loss, dehydration and worsening graft function that required immediate hospitalization. The symptoms did not diminish after dose reduction or withdrawal of mycophenolic acid derivatives. After excluding bacterial, viral, fungal, and parasite infections, colonoscopy with colonic biopsy was performed in both patients, which revealed features typical of colitis. Both patients received mesalazine until the symptoms stopped. In one of the patients, standard formulation of tacrolimus was immediately reintroduced. The second patient was given everolimus in an acute phase of diarrhea. Although the two cases presented in this report cannot fully support a causal relationship between the prolonged‐release tacrolimus and colitis, they should increase awareness among transplant physicians and prompt more close monitoring of such potential side effects as a part of the pharmacovigilance plan for a new formulation of the well‐established immunosuppressive drug.

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De Novo Crohn’s Disease in a Renal Transplant Recipient

Cited by 15 publications

References 5 publications

New insights into the dichotomous role of innate cytokines in gut homeostasis and inflammation

New insights into the dichotomous role of innate cytokines in gut homeostasis and inflammation

Pointers and pitfalls of mycophenolate-associated colitis

Two cases of severe de novo colitis in kidney transplant recipients after conversion to prolonged-release tacrolimus

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