Rotavirus Infection in Adult Small Intestine Allografts: A Clinicopathological Study of a Cohort of 23 Patients

Abstract

Rotavirus enteritis (RVE) is increasingly recognized as a cause of small bowel allograft dysfunction but its significance in adult patients is unknown. We have studied 23 adult small bowel transplant patients aged 19.8-59 years (mean = 38.2 years), who were presented with diarrhea and tested positive for rotavirus by enzymelinked immunosorbent assay methods. Serial followup biopsies, as well as clinical data, are documented and analyzed. These patients were followed up for an average of 168 days (range 33-534 days). Mean time of rotavirus diagnosis from transplant day was 794 days (range 38-2907 days). Self-limited diarrhea lasting 6-13 days (mean = 9 days) was the main presentation. Sixteen (69.6%) patients developed acute cellular rejection either concurrently with (i.e. six patients) or after (10 patients) RVE, often characterized by prominent mucosal plasmacytosis at an average of 22 days (range 0-94 days) from the day RVE was diagnosed. One-third of patients with acute rejection (i.e. five out of 16) required muromonab-CD3 rescue therapy. Two patients experienced graft loss (one from chronic rejection, another from sepsis). Rotavirus infection is a cause of diarrhea in adult small bowel transplant patients. The infection appeared to trigger cellular rejection that was associated with mucosal plasmacytosis, and sometimes required aggressive rescue therapy.

Opportunistic viral infections in intestinal transplantation

“…In a case series, rotavirus was the most common etiologic agent of diarrhea after IT, and the infections were diagnosed at a median of 75 days (range: 33-1800 days) after transplantation [125]. Rotavirus enteritis in IT was associated with late cellular rejection, probably because of subtherapeutic drug levels during the period of diarrhea or by stimulation of the cellular immune response and activation of the cytokine cascade by the viral infection [136]. Rotavirus infections should be diagnosed with stool rotavirus antigen enzyme assay in correlation with corresponding clinical symptoms and small bowel biopsy.…”

“…Rotavirus infections are diagnosed mainly in the winter season in the USA. Rotavirus infection in IT is increasingly recognized [136,138]. In a case series, rotavirus was the most common etiologic agent of diarrhea after IT, and the infections were diagnosed at a median of 75 days (range: 33-1800 days) after transplantation [125].…”

“…It presents as a self-limited disease in immunocompetent patients, but a more prolonged disease in immunocompromised patients [136,137]. Rotavirus infections are diagnosed mainly in the winter season in the USA.…”

Acute cellular rejection in intra-abdominal solid organ allografts – immunology under the light microscope

“…More detailed report and description of Adenoviral and Rotavirus enteritis have been previously published. 23,25 Pancreas Pancreas transplant has become an acceptable alternative treatment for type 1, and increasingly for type 2, diabetes mellitus. 26,27 Whole pancreas transplant is the more commonly practiced method and is discussed here.…”

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

“…However, ABC may also be increased in crypts and therefore be confused with changes of acute cellular rejection. 35,44,45 In general, rotavirus-or calicivirus-associated enteritis is treated with either decrease in immunosuppression or no change in management.…”