mycophenolate mofetil / Generic mfg. - LARVOL DELTA

GERMLINE DRIVERS AND PROTECTORS BEHIND HEPATOCELLULAR CARCINOMA, GRAFT FIBROSIS AND DRUG INTOLERANCE IN LIVER TRANSPLANT RECIPIENTS: A WHOLE‑GENOME STUDY WITHIN THE "5000GENOMI@VDA" PROJECT (UEGW 2026) - "Variant analysis focused on a total of 286 genes involved in chronic liver diseases, key HCC drivers and pharmacogenes relevant to tacrolimus, cyclosporine, mycophenolate and azathioprine, to explore potential associations with pre-OLT HCC, post-OLT liver fibrosis and immunosuppressive drug toxicity... Among 20 OLT recipients, 18 (90%) were alive at last follow‑up in 2025, 9 (45%) had HCC before OLT and 6 (30%) showed significant liver fibrosis (F3–F4) after OLT.Mycophenolate mofetil was discontinued in 5 patients (25%) due to intolerance; in one of them we identified a UGT1A9 variant (c.622C>T, p.R208W) in the substrate‑binding domain, potentially altering enzymatic drug clearance.We identified variants as potential drivers (higher frequency in HCC+ or F3-F4 and higher than gnomAD1) and protectors (higher frequency in HCC- or F0-F2 and lower than gnomAD1)... This study identified drivers and protective germline variants in cancer‑predisposing, fibrogenic and..."

Clinical • Fibrosis • Hepatocellular Cancer • Hepatology • Immunology • Liver Cirrhosis • Oncology • Solid Tumor • Transplantation • EFEMP1 • EPHX1 • UGT1A9

LONG-TERM CORTICOSTEROID THERAPY AND RECURRENCE AFTER LIVER TRANSPLANTATION IN AUTOIMMUNE AND CHOLESTATIC LIVER DISEASES: A TWO-CENTRE EXPERIENCE IN ROME (UEGW 2026) - "Tacrolimus-based regimens were used in most cases, with mycophenolate mofetil in 4 patients... In this cohort, although limited by the small sample size, 16% of patients developed recurrence after LT, with a median time of 5 years. Marked variability in long-term corticosteroid use was observed, particularly in cholestatic diseases, reflecting the lack of standardised strategies and the uncertain role of corticosteroids in this setting. Larger studies are needed to better define their use, especially given the unclear indications for corticosteroid therapy in cholestatic diseases."

Autoimmune Hepatitis • Cholestasis • Hepatology • Immunology • Inflammation • Primary Biliary Cholangitis • Primary Sclerosing Cholangitis • Transplantation

AUTOIMMUNE HEPATITIS: CORRELATIONS BETWEEN HISTOLOGY, CLINICAL PHENOTYPE AND TREATMENT RESPONSE (UEGW 2026) - "Treatment combined corticosteroids (100%) with azathioprine (91.7%) or mycophenolate mofetil (13.9%). This study highlights the major prognostic value of histological analysis in AIH and the complexity of the relationship between histological findings, clinical profile and treatment response. The absence of correlation between fibrosis stage and treatment response suggests that immunosuppression retains its efficacy even at advanced stages, while severe fibrosis and associated vascular abnormalities reflect an increased risk of portal complications. These findings support the role of systematic histological evaluation for both diagnostic and prognostic purposes within a multidisciplinary management approach."

Clinical • Autoimmune Hepatitis • Cardiovascular • Cholestasis • Endocrine Disorders • Fibrosis • Hepatitis C • Hepatology • Immunology • Inflammation • Portal Hypertension • Primary Biliary Cholangitis

CHOLANGITIS AS AN IMMUNE CHECKPOINT INHIBITOR INDUCED ADVERSE EVENT: MANAGEMENT AND TREATMENT OPTIONS INCLUDING TOCILIZUMAB & UDCA (UEGW 2026) - "He was treated with glucocorticosteroids (GCS) and mycophenolate mofetil (MMF), ICIs were discontinued...She was treated with GCS, MMF and ursodeoxycholic acid (UDCA) to no avail with bilirubin still increasing...Case report 3: A 78-year-old female patient was treated for squamous cell cancer of the lip with pembrolizumab and evorpacept (ALX-148) in the context of a clinical trial for progressive disease...Case report 4: A 69-year-old man with metastatic melanoma was commenced on ipilimumab and nivolumab... ICI-C is a rare, but potentially life-threatening AE. Based on our experience, we advocate for: 1) an urgent work-up (laboratory, imaging); 2) an early liver biopsy if MRCP / EUS show no or very mild biliary pathology and 3) if ICI-C is confirmed, we recommend prompt commencement of immunosupressive therapy. Poor response to steroids needs to be taken into account."

Adverse events • Checkpoint inhibition • Cholestasis • Hepatology • Melanoma • Oncology • Oral Cancer • Solid Tumor • Squamous Cell Carcinoma • Squamous Cell Carcinoma of Head and Neck

IGA VASCULITIS (HENOCH–SCHÖNLEIN PURPURA) UNDER TUMOUR NECROSIS FACTOR INHIBITOR THERAPY IN INFLAMMATORY BOWEL DISEASE: ADVERSE DRUG REACTION OR CONCOMITANT IMMUNE-MEDIATED DISEASE? (UEGW 2026) - "After smoking cessation, she developed a corticosteroid-refractory moderate-to-severe flare and started adalimumab...Oral corticosteroids were started; due to suboptimal response, mycophenolate mofetil was added, achieving renal recovery and progressive skin improvement. After switching to upadacitinib, she remained asymptomatic.IgA vasculitis (Henoch–Schönlein purpura) is a small-vessel vasculitis reported with anti-TNF therapy and also within the spectrum of immune-mediated inflammatory diseases (IMID). Although temporally related, in our case onset after anti-TNF withdrawal makes a direct causal relationship uncertain.This case highlights three key points: (i) anti-TNF may be associated with IgA vasculitis, although distinguishing drug-induced disease from IMID remains challenging, (ii) renal involvement may be severe and require escalation of immunosuppression, and (iii) early recognition and prompt withdrawal (if applicable) are essential to prevent..."

Adverse drug reaction • Gastroenterology • Gastrointestinal Disorder • Glomerulonephritis • IgA Nephropathy • Immunology • Inflammatory Bowel Disease • Lupus Nephritis • Nephrology • Oncology • Renal Disease • Tobacco Cessation • Ulcerative Colitis • Vasculitis

LATE-ONSET GRAFT-VERSUS-HOST DISEASE FOLLOWING DECEASED DONOR LIVER TRANSPLANTATION IN AN ADOLESCENT: A MISSED DIAGNOSIS WITH FATAL OUTCOME (UEGW 2026) - "Clinical Case Summary: Clinical Case Summary: A 16-year-old Sri Lankan female with advanced chronic liver disease from autoimmune hepatitis underwent ABO-compatible deceased donor liver transplantation (DDLT) (February 2025; CTP class B, MELD 16) and was on tacrolimus, mycophenolate mofetil, and prednisolone.Post-transplant course was marked by recurrent T-CmACR at months one and two, treated with methylprednisolone pulses and escalating immunosuppression. Acute kidney injury (AKI) (creatinine 154 µmol/L; tacrolimus 15.1 ng/mL), prompted substitution of tacrolimus with cyclosporine and addition of everolimus...The patient died in February 2026. GVHD at nine months post-DDLT is well outside the classical two-to-eight-week window, a late presentation rarely documented in solid organ transplantation.Repeated immunosuppressive escalation for recurrent T-CmACR likely eroded recipient immune surveillance, permitting unchecked donor lymphocyte expansion, a mechanism..."

Acute Kidney Injury • Autoimmune Hepatitis • Graft versus Host Disease • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Metabolic Disorders • Nephrology • Septic Shock • Solid Organ Transplantation • Transplantation

WHEN ABSCESSES MIMIC METASTASES: A RARE CASE OF PERFORATED COLORECTAL CANCER AND BRAIN ABSCESS IN CROHN'S PATIENT POST LIVER TRANSPLANTATION (UEGW 2026) - "After years of mesalazine-controlled intestinal disease, CD flares developed despite unchanged post-OLT immunosuppression with tacrolimus, mycophenolate mofetil and prednisone. In 2024, after seven months of vedolizumab therapy, he presented with recurrent abdominal pain...This case shows that colorectal cancer in PSC-IBD may be masked by chronic inflammation despite surveillance, and that post-transplant extraintestinal lesions require histological verification and interval imaging before metastases are assumed. The atypical presentation as intestinal perforation and diagnostic pitfalls of pseudometastatic lesions are worth discussion."

Clinical • Brain Cancer • CNS Disorders • Colorectal Adenocarcinoma • Colorectal Cancer • Crohn's disease • Gastroenterology • Gastrointestinal Disorder • Hepatology • Immunology • Oncology • Primary Sclerosing Cholangitis • Solid Tumor • Transplantation

EXTENSIVE UPPER GASTROINTESTINAL CYTOMEGALOVIRUS DISEASE WITH DUODENAL INVOLVEMENT IN AN IMMUNOCOMPROMISED PATIENT (UEGW 2026) - "She had received rituximab for three years and mycophenolate mofetil during the past year...Serum CMV PCR showed a high viral load (19,069 IU/mL).Immunosuppressive therapy was temporarily discontinued, and the patient was treated with intravenous ganciclovir (300 mg/day) for 14 days along with proton pump inhibitors...Although gastric and esophageal involvement is more common, duodenal disease is rare. This case highlights the importance of early endoscopic evaluation and biopsy for definitive diagnosis, as well as the potential for severe complications despite appropriate antiviral therapy."

Clinical • Cytomegalovirus Infection • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Myositis • Rare Diseases

Dynamics of Anti-HBc Serology During Anti-CD20 Therapy: Incidence, Timing, and Predictors of Anti-HBc Seroclearance in a Retrospective Cohort. (PubMed, Medicina (Kaunas)) - "Younger age (adjusted hazard ratio (aHR) 0.96, 95% confidence interval (CI) 0.93-0.98; p = 0.001), fewer anti-CD20 treatment cycles (aHR 0.90, 95% CI 0.83-0.99; p = 0.025), and mycophenolate mofetil therapy (aHR 2.52, 95% CI 1.14-5.56; p = 0.022) were independently associated with anti-HBc seroclearance...Despite seroclearance, HBV reactivation may still occur, indicating that anti-HBc loss should not be considered evidence of elimination of HBV-related immunological risk. These findings improve our understanding of HBV serological dynamics during anti-CD20 therapy and support maintaining current antiviral prophylaxis and virological monitoring strategies regardless of anti-HBc seroclearance."

Journal • Retrospective data • Hepatitis B • Infectious Disease • Inflammation

Pre-Analytical Stability of Mycophenolic Acid and Its Glucuronide in Saliva Samples Stored in Cotton Salivette® Devices Before Centrifugation. (PubMed, Pharmaceutics) - "Prompt centrifugation and processing are advisable when MPAG determination is required. Confirmation using incurred post-dose saliva from pediatric patients receiving mycophenolate mofetil is required."

Journal • Pediatrics

Juvenile Systemic Sclerosis in a Single Center: Clinical Features, Capillaroscopic Findings, Immunological Profile, and Treatment Outcomes-A Retrospective Descriptive Analysis. (PubMed, Children (Basel)) - "Two first-line regimens were compared: glucocorticosteroids with penicillamine (PA, n = 19) versus glucocorticosteroids with DMARDs (methotrexate, mycophenolate mofetil, or cyclophosphamide; n = 21). ILD and J4S > 15 were associated with escalation to biologic therapy, and earlier switching to rituximab may be beneficial in refractory patients. Future prospective multicenter studies are needed to validate these findings."

Journal • Retrospective data • Cardiovascular • Immunology • Interstitial Lung Disease • Pediatrics • Pulmonary Disease • Respiratory Diseases • Rheumatology • Scleroderma • Systemic Sclerosis

Occurrence of progressive pulmonary fibrosis and its association with survival in connective tissue disease-associated interstitial lung disease: an international retrospective cohort study. (PubMed, Rheumatol Int) - "Following PPF onset, the most frequently prescribed therapies were corticosteroids (72.8%), mycophenolate mofetil (52.4%), and antifibrotics (51.0%)...Earlier PPF onset was associated with higher mortality risk, but missing lung function data, surveillance differences, time-related bias, and residual confounding limit causal interpretation. Prospective studies using harmonised PPF adjudication and time-dependent analyses are needed."

Journal • Retrospective data • Immunology • Inflammatory Arthritis • Interstitial Lung Disease • Pulmonary Disease • Respiratory Diseases • Rheumatoid Arthritis • Rheumatology • Scleroderma • Systemic Sclerosis

Immune Checkpoint Inhibitor-Related Pancreatic Injury in Patients with Lung Cancer: Diagnostic Challenges, Multidisciplinary Management, and Outcomes. (PubMed, Cancers (Basel)) - "One patient received mycophenolate mofetil, and one developed acute necrotizing pancreatitis requiring intensive care, endoscopic procedures, and repeated surgical interventions...Management should be individualized, and severe cases may require early multidisciplinary involvement. The benefits of corticosteroids and routine pancreatic enzyme monitoring remain uncertain."

Checkpoint inhibition • Journal • Critical care • Lung Cancer • Oncology • Pancreatic Cancer • Pancreatitis • Solid Tumor

Safety of Biologic Therapy for Inflammatory Bowel Disease in Liver Transplant Recipients. (PubMed, Biomedicines) - "No significant safety signals were observed regarding hepatotoxicity, susceptibility to infections, or interactions with concomitant immunosuppressive therapy, including tacrolimus, mycophenolate mofetil, ciclosporin, and prednisolone. Therefore, biologic therapy combined with conventional post-transplant immunosuppression appears feasible and well tolerated in LT recipients with active IBD; larger prospective studies are needed. However, larger prospective studies are needed to confirm these findings."

Journal • Autoimmune Hepatitis • Crohn's disease • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hepatitis B • Hepatology • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Liver Cirrhosis • Primary Sclerosing Cholangitis • Transplantation • Ulcerative Colitis

Therapeutic strategies in childhood diffuse alveolar haemorrhage and idiopathic pulmonary hemosiderosis, a CRC chILD-EU study (ERS 2026) - "Treatments were classified into four categories: first-line (corticosteroids), second-line (hydroxychloroquine), third-line (mycophenolate mofetil, Janus kinase inhibitors, azathioprine), and last-resort therapies (cyclophosphamide, rituximab, obinutuzumab, plasma exchange, embolization). This study identifies new risk factors for IPH recurrence and shows that standard first- and second-line therapies do not reduce relapse risk. Third-line treatments appear effective and their role in long-term IPH management warrants reconsideration."

Clinical • Developmental Disorders • Genetic Disorders • Immunology • Pulmonary Disease • Respiratory Diseases

Checkmate: A Case of Severe Refractory Immune Checkpoint Inhibitor Hepatitis (ACG 2026) - "Case Description/ A 54-year-old female with stage IC1 clear cell ovarian cancer with liver metastases was treated with lorigerlimab, a bispecific CTLA-4/PD-1 inhibitor, two months prior to presenting with elevated liver enzymes...She received methylprednisolone 100 mg daily for 3 days followed by outpatient prednisone taper for presumed ICI hepatitis...She was then started on IV methylprednisolone 60 mg twice daily and mycophenolate mofetil (MMF) 500 mg twice daily. Ursodiol was added for ductopenia...Figure: Figure 1. Liver Biopsy, hematoxylin and eosin stain, 400x magnification (A) Endothelialitis is shown with neutrophils and lymphocytes undermining and displacing the endothelial cells; (B) Zone 3 is present with lymphohistiocytic inflammation and mild sinusoidal dilation with congestion; (C) this portal tract lacks a primary bile duct concerning for bile duct loss, (D) Bile duct injury is shown characterized by vacuolization of the biliary epithelium with a few..."

Checkpoint inhibition • Clinical • Gastrointestinal Disorder • Hepatology • Inflammation • Liver Failure • Oncology • Ovarian Cancer • Ovarian Clear Cell Cancer • Solid Tumor

Clinical and immunological outcomes of rituximab-based, mycophenolate mofetil-based and cyclophosphamide-based treatment strategies for systemic lupus erythematosus with active kidney involvement from LOOPS registry. (PubMed, RMD Open) - "The 52-week clinical effectiveness of the RTX-based, MMF-based and IVCY-based strategies for active lupus nephritis did not differ significantly. Different within-strategy immunophenotypic patterns were observed, but between-strategy differences were not confirmed. Comprehensive immunophenotyping may help characterise immune dynamics and support future response stratification and precision medicine for lupus nephritis."

Journal • Retrospective data • Glomerulonephritis • Immunology • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Renal Disease • Systemic Lupus Erythematosus

A Rare Case of Jejunal Variceal Bleeding in the Absence of Portal Hypertension Following Liver Transplantation (ACG 2026) - "Case Description/ 45 year old patient with ulcerative colitis (UC) status post total colectomy with end ileostomy, primary sclerosing cholangitis (PSC) complicated by hepatocellular carcinoma (HCC) status post liver transplant in 2020 with recent mycophenolate mofetil weaning and history of Roux-en-Y hepaticojejunostomy who presented with cramping abdominal pain with maroon, malodorous stool...Liver transplantation shrinks portosystemic collaterals which improves portal hypertension, effectively decreasing the risk of ectopic variceal bleed. This case helps raise awareness for ectopic varices as an etiology of obscure GI bleeding in liver transplant recipients without portal hypertension."

Clinical • Cardiovascular • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatocellular Cancer • Hepatology • Immunology • Inflammatory Bowel Disease • Portal Hypertension • Primary Sclerosing Cholangitis • Solid Tumor • Transplantation • Ulcerative Colitis • Varicose Veins

HTLV-1 Infection Following Liver Transplantation: A Rare Case of Donor-Derived Infection (ACG 2026) - "Immunosuppression management included basiliximab, tacrolimus, and mycophenolate mofetil. Although HTLV-1 has a long latency period of 10 to 30 years with a lifetime risk of 2-5% for HAM/TSP and ATLL, the diagnosis prompts concern in immunocompromised recipients. More studies are necessary to better understand appropriate management and screening of donor-associated HTLV transmission."

Clinical • Adult T-Cell Leukemia-Lymphoma • Fibrosis • Genetic Disorders • Hematological Malignancies • Hepatology • Immunology • Infectious Disease • Leukemia • Liver Failure • Lymphoma • Nephrology • Non-Hodgkin’s Lymphoma • Renal Disease • Septic Shock • Solid Organ Transplantation • Transplantation

An Unusual Case of Portal Hypertension Caused by Hepatic Sarcoidosis (ACG 2026) - "His T. Bili was 3.2 mg/dL, D. Bili was 0.9 mg/dL, and INR was 2.9, likely due to warfarin...He was started on prednisone taper and azathioprine, but due to intolerance, was later switched to mycophenolate mofetil...Corticosteroids and ursodeoxycholic acid are commonly used. Refractory cases may require immunosuppressive agents such as azathioprine. Liver transplant should be considered in HS once complications of PH develop as survival rates at 1-year are 78%-84.6% and 5-year are 61%."

Clinical • Cardiovascular • CNS Disorders • Fibrosis • Hematological Disorders • Hematological Malignancies • Hepatic Encephalopathy • Hepatology • Immunology • Infectious Disease • Lymphoma • Metabolic Dysfunction-Associated Steatotic Liver Disease • Portal Hypertension • Respiratory Diseases • Sarcoidosis • Thrombosis • Tuberculosis

Induction Immunosuppression in Liver Transplant: Is More Better? (ACG 2026) - "Standard regimens include perioperative corticosteroids and calcineurin inhibitors, with adjunctive mycophenolate mofetil (MMF) or T-cell-specific antibodies in select cases... Among 120,411 total transplants (2003â2021), 12,971 patients (18.3%) experienced acute rejection. Mean AR rates were 11.9% for Tacrolimus/MMF, 11.9% for Tacrolimus/Steroids, and 12.4% for Tacrolimus/MMF/Steroids. Steroid-sparing versus steroid-containing strategies showed no statistically significant difference in AR."

Solid Organ Transplantation • Transplant Rejection • Transplantation

Mycophenolate-Induced Chronic Active Colitis in a Renal Transplant Recipient With Normal Endoscopy: A Mimicker of Inflammatory Bowel Disease (ACG 2026) - "Introduction: Mycophenolate mofetil (MMF) causes gastrointestinal side effects in up to 45% of transplant recipients, yet histologically confirmed colitis occurs in only 2â9%...Case Description/ A 22-year-old man with a deceased-donor renal transplant on tacrolimus, MMF, and prednisone presented with fatigue, dyspnea, and chronic diarrhea...Norovirus was treated with nitazoxanide...MMF discontinuation with azathioprine substitution is the preferred strategy and yields rapid improvement...(B): Representative colon biopsy slide at 40x image (H&E). Neutrophilic cryptitis - neutrophils infiltrating the crypt and apoptosis of the crypt epithelial cells (arrow)."

Clinical • Acute Kidney Injury • Chronic Kidney Disease • Cytomegalovirus Infection • Eosinophilia • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Nephrology • Pulmonary Disease • Transplantation

A Carpeted Esophagus: Diffuse Squamous Papillomatosis in an Immunosuppressed Patient (ACG 2026) - "Case Description/ A 63-year-old male with polycystic kidney disease status post renal transplant on mycophenolate mofetil (MMF) and GERD underwent routine EGD during pre-operative evaluation for conversion of laparoscopic adjustable gastric band to sleeve gastrectomy...This case underscores the importance of thorough endoscopic assessment even in asymptomatic patients and highlights the need for prospective data on surveillance intervals and outcomes in DESP. Figure: Numerous diffuse sessile and pedunculated squamous papillomas involving the entire esophagus creating a carpet like appearance in the distal esophagus"

Clinical • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Genetic Disorders • Nephrology • Polycystic Kidney Disease • Renal Disease

A Rare Culprit - Delayed Mycophenolate Mofetil-Induced Colitis in a Young Renal Transplant Patient (ACG 2026) - "Histopathology showed ulcerated mucosa with apoptosis, intraepithelial eosinophils, crypt abscesses, and increased inflammation within the lamina propria, with findings favoring MMF related colitis.Upon discontinuation of MMF, her symptoms improved and azathioprine was initiated. It is also important to complete an infectious workup prior to attributing MMF colitis.The management is either dose reduction to test for tolerability or in severe cases, changing to another medication. Our case highlights the need for a high index of suspicion for MMF-induced GI toxicity and emphasizes that it can occur even after nearly a decade of drug tolerance."

Clinical • Acute Kidney Injury • Chronic Kidney Disease • Gastroenterology • Gastrointestinal Disorder • Graft versus Host Disease • Immunology • Inflammation • Inflammatory Bowel Disease • Nephrology • Pancreatitis • Solid Organ Transplantation • Transplantation • Type 1 Diabetes Mellitus • Ulcerative Colitis

Uncontrolled Systemic Lupus Erythematosus Causing Recurrent Pancreatitis (ACG 2026) - "The patient had previously been unable to tolerate multiple immunosuppressive therapies, including azathioprine, methotrexate, mycophenolate sodium, and mycophenolate mofetil, and was not consistently following with rheumatology or receiving treatment for SLE. Rheumatology was consulted during admission, and treatment was initiated with dexamethasone, cyclophosphamide, and hydroxychloroquine...Clinicians should maintain a high index of suspicion for pancreatitis in SLE patients presenting with abdominal pain, particularly those with poorly controlled disease. This case also emphasizes the importance of consistent rheumatologic follow-up and immunosuppressive therapy, as adequate control of underlying SLE reduces the risk of recurrent pancreatic inflammation and complications."

Cardiovascular • Chronic Kidney Disease • Gastroenterology • Glomerulonephritis • Hypertension • Immunology • Inflammation • Inflammatory Arthritis • Lupus • Lupus Nephritis • Nephrology • Pancreatitis • Renal Disease • Systemic Lupus Erythematosus