Allograft biopsy findings in patients with small bowel transplantation

Abstract

In this study, we sought to determine the incidence of post-transplant complications including acute cellular rejection (ACR), infection, and post-transplant lymphoproliferative disease (PTLD) in mucosal allograft biopsies in patients with small bowel transplant at our institution. We retrospectively reviewed pathology reports from 5675 small bowel allograft biopsies from 99 patients and analyzed the following: indications for biopsy, frequency and grade of ACR, the presence of infectious agents, results of workup for potential PTLD, results of C4d immunohistochemistry (IHC), features of chronic mucosal injury, and findings in concurrent native bowel biopsies. Findings from 42 allograft resection specimens were also correlated with prior biopsy findings. Indeterminate, mild, moderate, and severe ACR were seen in 276 (4.9%), 409 (7.2%), 100 (1.8%), and 207 (3.6%) of biopsies, respectively. Although ACR may show histologic overlap with mycophenolate mofetil toxicity, we found the analysis of concurrent native bowel biopsies to be helpful in this distinction. Adenovirus was the most common infectious agent seen (11%), and we routinely performed adenovirus IHC on biopsies. Eighteen patients (18%) developed PTLD, 83% of which were EBV associated, but only 28% of PTLD cases were diagnosed on mucosal allograft biopsies. C4d IHC did not correlate with the presence of donor-specific antibodies in limited cases.

Effect ofCXCR3/HO-1genes modified bone marrow mesenchymal stem cells on small bowel transplant rejection

“…As there is continual exchange of cells and antigens during congenital and acquired immune function, T cell-mediated acute cellular rejection[25] and antibody-mediated humoral rejection[26] are very likely to occur after small bowel transplantation. Studies have demonstrated that after small bowel transplantation, even under the application of a conventional immunization regimen, the incidence of rejection remains high[27,28]. The need to find a better method for induction of immune tolerance or transplantation rejection, has led to studies exploring whether BMMSCs can inhibit rejection after small bowel transplantation[29].…”

Gastrointestinal manifestations, risk factors, and management in patients with post-transplant lymphoproliferative disorder: A systematic review

“…Out of a total of 472 patients, 56 patients (11.9%) had gastric PTLD while 415 patients (88.1%) had PTLD in other locations[ 13 ] (Table 1 ). The small bowel is another common area of involvement, PTLD of the small bowel was diagnosed in 50% of patients having PTLD after small bowel transplantation (SBT)[ 14 ]. In patients requiring surgery for GI-PTLD complications, organ involvement varied: Small bowel (50%), proximal right colon (31.2%), and stomach, duodenum, and transverse colon (6.2%)[ 15 ].…”

Pathology of Intestinal Transplantation: Rejection and a Case of Tolerance

“…For example, mechanical failure of the graft due to operation during surgery may occur during the early phase after transplantation. Cytomegalovirus (CMV) enteritis and Epstein-Barr virus -related enteritis are severe side effects and post-transplantation lymphoproliferative disorders/diseases [13][14][15]. It is often difficult to make a differential diagnosis of the ACR findings.…”