Mycophenolate Mofetil and Pulmonary Fibrosis After Kidney Transplantation: A Case Report

Abstract

Patient: Male, 50Final Diagnosis: Pulmonary fibrosisSymptoms: Short of breathMedication: —Clinical Procedure: —Specialty: TransplantologyObjective:Adverse events of drug therapyBackground:Mycophenolate mofetil (MMF) induced lung disease has been described in only a few isolated reports. We report a case of fatal respiratory failure associated with MMF after kidney transplantation.Case Report:A 50-year-old Hispanic male with a history of end-stage renal disease secondary to hypertension underwent deceased donor kidney transplantation. His preoperative evaluations were normal except for a chest x-ray which showed bilateral interstitial opacities. Tacrolimus and MMF were started on the day of surgery. His postoperative course was uneventful and he was discharged on postoperative day 5. One month later, he presented with shortness of breath and a cough with blood-tinged sputum. His respiratory condition deteriorated rapidly, requiring intubation. Chest computer tomography (CT) demonstrated patchy ground-glass opacities with interlobular septal thickening. Comprehensive pulmonary, cardiac, infectious, and immunological evaluations were all negative. Open lung biopsy revealed extensive pulmonary fibrosis with no evidence of infection. He temporarily improved after discontinuation of tacrolimus and MMF, however, on resuming MMF his respiratory status deteriorated again and he subsequently died from hypoxic respiratory failure.Conclusions:An awareness of pulmonary lung disease due to MMF is important to prevent adverse outcomes after organ transplantation. MMF must be used with utmost care in recipients with underlying lung disease as their pulmonary condition might make them more susceptible to any harmful effects of MMF.

Enhanced Production of Mycophenolic Acid from Penicillium brevicompactum via Optimized Fermentation Strategy

“…In addition, mycophenolate mofetil, a 2-malinyl ethyl ester derivative of MPA, is used to prevent rejection after organ and tissue transplantation [ 13 , 14 ]. At present, a variety of MPA-based immunosuppressants have been commercialized, such as Cellcept and Myfortic [ 15 , 16 ]. Given such known functions, the production of MPA with high efficiency tends to be important to improve the production level.…”

Production of Mycophenolic Acid by a Newly Isolated Indigenous Penicillium glabrum

“…Mycophenolic acid (MPA) is an antibiotic and immunosuppressant drug which is commercialized as mycophenolate mofetil (MMF) and mycophenolate sodium for the prevention of organ transplant rejection [1,2]. MPA and its derivatives have diverse biological properties and have been extensively studied for their antineoplastic, anti-inflammatory, anti-psoriasis, antifungal and antiviral activities [3,4].…”

“…It is a selective and non-competitive inhibitor of the enzyme Inosine Monophosphate DeHydrogenases (IMPDH) involving in de novo biosynthesis of guanosine nucleotide, the only supporting pathway of purines synthesis in both B and T lymphocytes [4]. Inhibition of IMPDH arrests cell proliferation as a result of DNA and RNA biosynthesis blocking [2,6].…”