Ask the Experts - Cough in the Kidney Transplant Recipient?
Ask the Experts - Cough in the Kidney Transplant Recipient?
After excluding the most common causes of chronic cough in a kidney transplant recipient, may we ascribe the cough to mycophenolate mofetil (MMF)?
Rogerio Silva, MD
There are 2 references in the literature that describe transplant recipients who have cough as a consequence of receiving MMF. The first report of significant respiratory problems with MMF involved a 51-year-old woman on MMF and tacrolimus (TAC) who developed cough and pulmonary failure. MMF and TAC were withdrawn and the patient recovered. MMF was restarted with clinical relapse. The patient recovered after MMF was withdrawn the second time. All cultures and biopsies were negative. In the other report, MMF was withdrawn in 5 of 45 cadaveric renal transplant recipients because of persistent cough. The symptoms resolved within 3 to 4 weeks after withdrawal. The product literature for MMF mentions cough as a side effect, but the incidence of the complaint was not different from control kidney transplant recipients.
Despite these reports, it can be difficult to precisely ascertain the cause of side effects in transplant recipients. In my own experience over the last 10 years, I cannot recall a single case of chronic cough related to the administration of MMF. It is useful to evaluate patients for the most common causes of chronic cough, which include asthma, congestive heart failure, postnasal drip, and administration of angiotensin-converting enzyme inhibitors. If no cause can be found, then careful withdrawal of MMF should be considered. Rechallenge with the drug could also help clarify the cause and effect relationship of the symptom and the drug.
After excluding the most common causes of chronic cough in a kidney transplant recipient, may we ascribe the cough to mycophenolate mofetil (MMF)?
Rogerio Silva, MD
There are 2 references in the literature that describe transplant recipients who have cough as a consequence of receiving MMF. The first report of significant respiratory problems with MMF involved a 51-year-old woman on MMF and tacrolimus (TAC) who developed cough and pulmonary failure. MMF and TAC were withdrawn and the patient recovered. MMF was restarted with clinical relapse. The patient recovered after MMF was withdrawn the second time. All cultures and biopsies were negative. In the other report, MMF was withdrawn in 5 of 45 cadaveric renal transplant recipients because of persistent cough. The symptoms resolved within 3 to 4 weeks after withdrawal. The product literature for MMF mentions cough as a side effect, but the incidence of the complaint was not different from control kidney transplant recipients.
Despite these reports, it can be difficult to precisely ascertain the cause of side effects in transplant recipients. In my own experience over the last 10 years, I cannot recall a single case of chronic cough related to the administration of MMF. It is useful to evaluate patients for the most common causes of chronic cough, which include asthma, congestive heart failure, postnasal drip, and administration of angiotensin-converting enzyme inhibitors. If no cause can be found, then careful withdrawal of MMF should be considered. Rechallenge with the drug could also help clarify the cause and effect relationship of the symptom and the drug.
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