International Grading Scheme for Acute Cellular Rejection in Small-Bowel Transplantation: Single-Center Experience

Ruiz, Phillip; Takahashi, Hitomi; Delacruz, Victor; Island, Eddie; Selvaggi, Gennaro; Nishida, Seigo; Moon, Jang; Smith, Leslie; Asaoka, Tadafumi; Levi, David; Tekin, Akin; Tzakis, Andreas G.

doi:10.1016/j.transproceed.2009.12.026

Cited by 41 publications

(23 citation statements)

References 28 publications

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“…Moderate‐to‐severe ACR was infrequent in our study, occurring in only 5.4% of all biopsies, and the presence and severity of ACR did not appear to correlate with graft type. Overall, the prevalence and distribution of ACR severity in our study was slightly different from those reported previously by the group at University of Miami, who looked at 3484 biopsy samples from 155 patients . While both studies showed a somewhat similar percentage of ACR as a whole (12.6% vs 17%), we had a much higher rate of no ACR (77% vs 33.9%) and a much lower percentage of indeterminate for ACR (4.9% vs 49.1%); however, differences in rates of no ACR and indeterminate for ACR are likely of little clinical significance.…”

Section: Discussioncontrasting

confidence: 96%

Allograft biopsy findings in patients with small bowel transplantation

Koo

Dawson

Dry

et al. 2016

Clinical Transplantation

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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.

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Section: Discussioncontrasting

confidence: 96%

Allograft biopsy findings in patients with small bowel transplantation

Koo

Dawson

Dry

et al. 2016

Clinical Transplantation

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“…The severity of ACR is usually graded as mild, moderate, or severe based on pathologic findings [14,15]. Pathological readings of "indeterminate" rejection (suspicious but not clear-cut findings to meet criteria for "mild") need to be correlated with endoscopic and clinical findings and, if necessary, endoscopy and biopsy are repeated for a definitive diagnosis.…”

Section: Acute Cellular Rejectionmentioning

confidence: 99%

Clinical Allograft Rejection Syndromes in Intestinal Transplantation

Tzakis

Selvaggi

Tekin

et al. 2014

Textbook of Organ Transplantation

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“…15,16 Acute Cellular Rejection: Grading System In small-bowel transplants, several similar grading schemes have been published for evaluating rejection. [17][18][19][20] In all these schemes the apoptotic body count (ABC), which is defined as the number of apoptotic bodies seen in 10 consecutive crypt cross-sections, is a key parameter that is useful in diagnosing rejection, particularly mild rejection or cases indeterminate for rejection. Crypt cell apoptosis is a process that is important for the physiologic regulation of the intestinal epithelium but is far more extensive in rejection.…”

Section: Acute Cellular Rejectionmentioning

confidence: 99%

Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations

Remotti

Subramanian²,

Martínez³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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Context.—Intestinal transplant has become a standard treatment option in the management of patients with irreversible intestinal failure. The histologic evaluation of small-bowel allograft biopsy specimens plays a central role in assessing the integrity of the graft. It is essential for the management of acute cellular and chronic rejection; detection of infections, particularly with respect to specific viruses (cytomegalovirus, adenovirus, Epstein-Barr virus); and immunosuppression-related lymphoproliferative disease. Objective.—To provide a comprehensive review of the literature and illustrate key histologic findings in small-bowel biopsy specimen evaluation of patients with small-bowel or multivisceral transplants. Data Sources.—Literature review using PubMed (US National Library of Medicine) and data obtained from national and international transplant registries in addition to case material at Columbia University, Presbyterian Hospital, and Mount Sinai Medical Center, New York, New York. Conclusions.—Key to the success of small-bowel transplantation and multivisceral transplantation are the close monitoring and appropriate clinical management of patients in the posttransplant period, requiring coordinated input from all members of the transplant team with the integration of clinical, laboratory, and histopathologic parameters.

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International Grading Scheme for Acute Cellular Rejection in Small-Bowel Transplantation: Single-Center Experience

Cited by 41 publications

References 28 publications

Allograft biopsy findings in patients with small bowel transplantation

Allograft biopsy findings in patients with small bowel transplantation

Clinical Allograft Rejection Syndromes in Intestinal Transplantation

Small-Bowel Allograft Biopsies in the Management of Small-Intestinal and Multivisceral Transplant Recipients: Histopathologic Review and Clinical Correlations

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