A2.5-year-old girl underwent orthotopic liver transplantation (OLT) for cirrhosis secondary to progressive familial intrahepatic cholestasis. She was well until five days posttransplantation when she developed fever (up to 39 °C). At that time, she was receiving tacrolimus, cellcept and prednisolone. Her laboratory findings revealed a serum ALT of 70 IU/L, AST of 75 IU/L, Alk-P of 560 IU/L, and...

A 5-year-old boy underwent orthotopic liver transplantation (OLT) for cirrhosis secondary to tyrosinemia. His immediate post-transplant course was unremarkable. After five months, he developed fever (T >38 °C). At that time, he was receiving tacrolimus, cellcept and prednisolone. His laboratory findings revealed an ALT of 85 IU/L, AST 86 IU/L, Alk-P 730 IU/L, total billirubin of 2.5 and direct ...

Mycophenolic-acid (MPA) is a selective, non-competitive inhibitor of InosineMonophosphate-Dyhydrogenase (IMPDH) leading to the inhibition of the de-novo synthesis of guanosine-nucleotides. In human lymphocytes inhibition of IMPDH results in altered cellular proliferation with arrest in the S-phase of the cell cycle. Due to the absence of a salvage pathway, proliferating activated t-cells are se...

A 20-year-old Asian woman with a well-established history of systematic lupus erythematosus (SLE) and lupus nephritis (WHO stage IVB) presented to the emergency department with generalized arthralgia and headaches. Her current medications included cellcept 1000mg daily and prednisone 30mg daily. The patient had had low normal blood pressure in the past, and experienced episodes of hypotension w...

Methods:A candidate was chosen based on strict screening criteria including ongoing immunosuppression, proof of compliance and strong family support. The recipient was an eightyear-old quadrimembral amputee secondary to sepsis with distal forearm amputations who was functional with lower extremity prostheses but had failed upper extremity prostheses. A donor was found with ABO compatibility and...

Mycophenolate mofetil (CellCept®), a commonly used immunosuppressive drug in solid organ transplantation, has recently been shown to cause graft-versus-host disease (GVHD)-like changes in the gastrointestinal tract. On rare occasions, true GVHD has also been documented in the gastrointestinal tract of solid organ transplant patients. Because the treatment for these two entities is different, i....