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

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

Orthotopic small intestine transplantation in dogs with systemic graft drainage

BACKGROUND: Small intestine transplantation has been accepted worldwide to treat complex cases of intestinal failure. Canine intestinal transplantation model is important in training the surgical technique and to study the complications of this procedure. Systemic graft venous drainage is frequently performed in clinic, although the consequences of this partial meso-caval shunt have not been studied in detail. AIM: To describe the surgical technique and clinical outcome of a canine intestinal transplantation model using mesenteric-caval graft drainage. METHOD: Adult mongrel dogs from University of São Paulo Animal Facility, São Paulo, SP, Brazil, were used as donors and recipients in ten consecutives orthotopic intestinal transplantation with mesenteric-caval venous drainage. Clinical examination and body weight measurement were performed daily in all animals. Necropsy was performed in animals presenting moribund state (lethargic posture, diarrhea and loss of over 35% of body weight) to determine cause of death and histological changes. RESULTS: Three recipients died before day 2 from technical complications and were excluded from the experiment. The remaining seven animals developed signs of graft rejection with onset on days 3-4 and died or were sacrificed presenting severe graft rejection between days 7-9. Necropsy and histology of the graft confirmed the diagnosis of severe acute cellular rejection. CONCLUSION: Small intestine transplantation with systemic drainage in dogs courses with analogous and lethal outcome between postoperative day 7 to 9 due to strong graft rejection. This model serves as an excellent pre-clinical model to study the main complications related to this transplantation