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Mycophenolate Oral Ulceration Transplant — ESENeph MCQ

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EasyTransplantationMycophenolate Oral Ulceration TransplantESENeph

A kidney transplant recipient on Tacrolimus and Mycophenolate develops severe oral mucositis and mouth ulcers 3 months post-transplant. His Tacrolimus trough is 7 ng/mL. CMV PCR is negative. What should be considered?

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Correct answer: C — Mycophenolate-induced oral ulceration – a recognised dose-dependent side effect; dose reduction of Mycophenolate often resolves the ulcers; if persistent, consider switching to Azathioprine or enteric-coated Mycophenolate sodium (Myfortic)

Oral ulceration is a recognised side effect of Mycophenolate mofetil (occurring in 3-10% of patients), related to its antiproliferative effect on rapidly dividing mucosal epithelial cells. CMV should be excluded (CMV can cause oral ulcers in immunosuppressed patients). If CMV-negative, Mycophenolate dose reduction usually resolves the ulcers. Alternatives include switching to enteric-coated Mycophenolate sodium (Myfortic – may have better oral tolerability) or Azathioprine. Oral Sirolimus/Everolimus also commonly cause mouth ulcers (up to 30-60%) – important to distinguish from Mycophenolate-induced.

Reference: KDIGO 2009 – Transplant; BNF – Mycophenolate ADRs