Maes Bart D, Dalle Ignace, Geboes Karen, Oellerich Michael, Armstrong Victor W, Evenepoel Pieter, Geypens Benny, Kuypers Dirk, Shipkova Maria, Geboes Karel, Vanrenterghem Yves F Ch
Department of Medicine, Division of Nephrology, University Hospital Gasthuisberg, Leuven, Belgium.
Transplantation. 2003 Mar 15;75(5):665-72. doi: 10.1097/01.TP.0000053753.43268.F0.
Diarrhea is the most frequently reported adverse event in mycophenolate mofetil (MMF)-treated transplant patients. The aim of this study was to explore the gastrointestinal tract in MMF-treated renal transplant recipients with persistent afebrile diarrhea to characterize its nature and etiology.
Renal transplant recipients with persistent afebrile diarrhea (daily fecal output >200 g) were prospectively investigated for infections, morphologic, and functional (gastrointestinal motility and intestinal absorptive capacity) integrity of the gastrointestinal tract; 26 patients met the inclusion criteria.
All but one patient had an erosive enterocolitis. Seventy percent of the patients had malabsorption of nutrients, contributing to the diarrhea. In +/-60%, an infectious origin was demonstrated and successfully treated with antimicrobial agents without changes in immunosuppressive regimen. In +/-40%, no infection occurred, but a Crohn's disease-like pattern of inflammation was noted. These patients also had a less pronounced bile-acid malabsorption but a significant faster colonic transit time, correlating with the trough level of mycophenolic acid (MPA). Cessation of MMF, however, was associated with allograft rejection in one third of these patients.
Persistent afebrile diarrhea in renal transplant recipients is characterized by erosive enterocolitis, which is of infectious origin in +/-60%. In +/-40%, a Crohn's disease-like (entero-)colitis was present. Because reduction or cessation of MMF was the only effective therapy, MPA or one of its metabolites may be suggested as a possible cause. However, reduction or cessation of MMF was associated with an increased risk for rejection.
腹泻是接受霉酚酸酯（MMF）治疗的移植患者中最常报告的不良事件。本研究的目的是探究接受MMF治疗的肾移植受者出现持续无热腹泻时的胃肠道情况，以明确其性质和病因。
对出现持续无热腹泻（每日粪便量>200 g）的肾移植受者进行前瞻性研究，以评估胃肠道的感染情况、形态学以及功能（胃肠动力和肠道吸收能力）完整性；26例患者符合纳入标准。
除1例患者外，所有患者均患有糜烂性小肠结肠炎。70%的患者存在营养物质吸收不良，这导致了腹泻。约60%的患者证实有感染源，经抗菌药物成功治疗，免疫抑制方案未改变。约40%的患者未发生感染，但发现有克罗恩病样炎症模式。这些患者胆汁酸吸收不良不太明显，但结肠转运时间明显更快，这与霉酚酸（MPA）的谷浓度相关。然而，在这些患者中，三分之一的患者停用MMF后出现了移植肾排斥反应。
肾移植受者的持续无热腹泻以糜烂性小肠结肠炎为特征，约60%由感染引起。约40%的患者存在克罗恩病样（肠）结肠炎。由于减少或停用MMF是唯一有效的治疗方法，MPA或其代谢产物之一可能被认为是可能的病因。然而，减少或停用MMF与排斥反应风险增加有关。
