Graft assessment for acute rejection after intestinal transplantation: current status and future perspective

Varkey, Jonas

doi:10.1080/00365521.2020.1847318

Cited by 6 publications

(4 citation statements)

References 71 publications

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“…In the context of intestinal transplantation, graft assessment remains reliant on serial mucosal biopsies [28]. Temporary ostomies are often created to facilitate biopsy collection, avoiding complications associated with colonoscopies and minimizing patient discomfort.…”

Section: Ostomy New Variationsmentioning

confidence: 99%

Innovative surgical techniques in the intestine and multivisceral transplant

Abreu,

Manzi,

Vianna

2023

Current Opinion in Organ Transplantation

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Purpose of review This timely review delves into the evolution of multivisceral transplantation (MVT) over the past six decades underscoring how advancements in surgical techniques and immunosuppression have driven transformation, to provide insight into the historical development of MVT, shedding light on its journey from experimentation to a valuable clinical approach. Recent findings The review presents contemporary enhancements in surgical methods within the context of intestinal transplantation. The versatility of MVT is emphasized, accommodating diverse organ combinations and techniques. Both isolated intestinal transplantation (IIT) and MVT have seen expanded indications, driven by improved parenteral nutrition, transplantation outcomes, and surgical innovations. Surgical techniques are tailored based on graft type, with various approaches for isolated transplantation. Preservation strategies and ostomy techniques are also covered, along with graft assessment advancements involving donor-specific antibodies. Summary This review's findings underscore the remarkable evolution of MVT from experimental origins to a comprehensive clinical practice. The progress in surgical techniques and immunosuppression has broadened the spectrum of patients who can benefit from intestinal transplant, including both IIT and MVT. The expansion of indications offers hope to patients with complex gastrointestinal disorders. The detection of donor-specific antibodies in graft assessment advances diagnostic accuracy, ultimately improving patient outcomes.

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Section: Ostomy New Variationsmentioning

confidence: 99%

Innovative surgical techniques in the intestine and multivisceral transplant

Abreu,

Manzi,

Vianna

2023

Current Opinion in Organ Transplantation

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“…However, the discontinuation of scheduled biopsies after ileostomy closure poses challenges in the early detection of acute rejection [9,10]. Therefore, the identification of novel molecular biomarkers that can be non-invasively detected with high accuracy has been a crucial goal in aiding the clinical detection of rejection in intestinal transplantation [11][12][13].…”

Section: Introductionmentioning

confidence: 99%

Application of Intestinal Barrier Molecules in the Diagnosis of Acute Cellular Rejection After Intestinal Transplantation

Chen,

Tseng,

Chen

et al. 2023

Transpl Int

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Diagnosing acute rejection after intestinal transplantation currently heavily relies on histopathological analysis of graft biopsies. However, the invasive risks associated with ileoscopic examination and the inaccessibility for biopsy after ileostomy closure hinder real-time detection of rejection responses. Molecules comprising the intestinal barrier have been identified as physiological and molecular biomarkers for various bowel conditions and systemic diseases. To investigate the potential of barrier function-related molecules in diagnosing rejection after intestinal transplantation, plasma samples were collected longitudinally from transplant recipients. The samples were categorized into “indeterminate for rejection (IND)” and “acute rejection (AR)” groups based on clinical diagnoses at each time point. The longitudinal association between plasma levels of these barrier function-related molecules and acute rejection was analyzed using the generalized estimating equations (GEE) method. Logistic GEE models revealed that plasma levels of claudin-3, occludin, sIgA, and zonulin were independent variables correlated with the clinical diagnosis of acute rejection. The subsequent prediction model demonstrated moderate ability in discriminating between IND and AR samples, with a sensitivity of 76.0%, specificity of 89.2%, and accuracy of 84.6%. In conclusion, monitoring plasma levels of claudin-3, occludin, sIgA, and zonulin shows great potential in aiding the diagnosis of acute rejection after intestinal transplantation.

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“… 2 Unlike other solid organ transplant models, there are no universally accepted biochemical markers with which to diagnose, monitor, or even predict IT graft failure. 3 The current gold standard for post-IT evaluation involves constant and coordinated clinical, laboratory, and histopathologic testing. However, there is considerable variability over the approach and frequency of routine biopsy of acute cellular rejection (ACR) across approved IT programs in the United States.…”

Section: Introductionmentioning

confidence: 99%

Optical coherence tomography of small intestine allograft biopsies using a handheld surgical probe

et al. 2021

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. Significance: The current gold standard for monitoring small intestinal transplant (IT) rejection is endoscopic visual assessment and biopsy of suspicious lesions; however, these lesions are only superficially visualized by endoscopy. Invasive biopsies provide a coarse sampling of tissue health without depicting the true presence and extent of any pathology. Optical coherence tomography (OCT) presents a potential alternative approach with significant advantages over traditional white-light endoscopy. Aim: The aim of our investigation was to evaluate OCT performance in distinguishing clinically relevant morphological features associated with IT graft failure. Approach: OCT was applied to evaluate the small bowel tissues of two rhesus macaques that had undergone IT of the ileum. The traditional assessment from routine histological observation was compared with OCT captured using a handheld surgical probe during the days post-transplant and subsequently was compared with histophaology. Results: The reported OCT system was capable of identifying major biological landmarks in healthy intestinal tissue. Following IT, one nonhuman primate (NHP) model suffered a severe graft ischemia, and the second NHP graft failed due to acute cellular rejection. OCT images show visual evidence of correspondence with histological signs of IT rejection. Conclusions: Results suggest that OCT imaging has significant potential to reveal morphological changes associated with IT rejection and to improve patient outcomes overall.

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Graft assessment for acute rejection after intestinal transplantation: current status and future perspective

Cited by 6 publications

References 71 publications

Innovative surgical techniques in the intestine and multivisceral transplant

Innovative surgical techniques in the intestine and multivisceral transplant

Application of Intestinal Barrier Molecules in the Diagnosis of Acute Cellular Rejection After Intestinal Transplantation

Optical coherence tomography of small intestine allograft biopsies using a handheld surgical probe

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