Stool Calprotectin Monitoring After Small Intestine Transplantation

Mercer, David F.; Vargas, Luciano; Sun, Yimin; Moreno, Ana; Grant, Wendy J.; Botha, Jean F.; Langnas, Alan Norman; Sudan, Debra

doi:10.1097/tp.0b013e318215e709

Cited by 29 publications

(19 citation statements)

References 13 publications

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“…Stool calprotectin has been heralded as a potential biomarker, but it has significant interpatient variability and is unable to differentiate between infection and rejection. 7 Serum citrulline has also been considered, however, it has not been shown to predict asymptomatic rejection and also has significant variability between patients. 8 Immune cell function assay (Cylex ImmuKnow – Viracor IBT Laboratories) has been investigated, and while it may be used as an adjunctive diagnostic tool, it cannot replace endoscopy with biopsy.…”

Section: Discussionmentioning

confidence: 99%

Endoscopy Following Pediatric Intestinal Transplant

Yeh

Ngo

Wozniak

et al. 2015

J. pediatr. gastroenterol. nutr.

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Objectives Biopsies remain the gold standard in the diagnosis of intestinal transplant (ITx) rejection, and gastrointestinal endoscopy plays a pivotal role in patient management. Herein, we describe a single center 23 year endoscopic experience in pediatric ITx recipients. Methods A retrospective review of endoscopy and pathology reports of all ITx recipients <18 years old transplanted between 1991 and 2013 was performed with the aim of describing the procedural indications, findings, and complications. Results A total of 1770 endoscopic procedures within 1014 sessions were performed. Combination EGD and ileoscopy was the most common procedure (36%). Increased stool output (35%) and surveillance endoscopy (32%) were the most common indications. 162 episodes of biopsy proven rejection were diagnosed. First episode of rejection occurred at a median of 1 month post-ITx. 45% of histology-proven rejection had normal appearing endoscopies. The rate of procedural complications including but not limited to bleeding and perforation was 1.8%. Conclusions Endoscopy with biopsy plays a significant role in the care of ITx recipients. Multiple procedures are required for graft surveillance, diagnosis of rejection, subsequent treatment, and follow-up of therapy. The gross endoscopic appearance, particularly in mild to moderate acute cellular rejection, does not correlate well with histology. Complex anatomy, complication rates which are higher than non-ITx pediatric endoscopy cases, and timely histologic interpretation by experienced pathologists are reasons that these procedures should be performed at centers accustomed to caring for ITx recipients. The field would benefit from the development of a noninvasive biomarker to reliably and efficiently detect rejection.

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Section: Discussionmentioning

confidence: 99%

Endoscopy Following Pediatric Intestinal Transplant

Yeh

Ngo

Wozniak

et al. 2015

J. pediatr. gastroenterol. nutr.

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“…First, the ITR does not collect detailed perioperative data on donor selection criteria; specific surgical techniques; nutritional management; protocols to detect rejection; and protocols to prevent viral, bacterial and fungal infections (3,14,42,(60)(61)(62)(63). Second, the data provided to the ITR have not been audited or independently verified.…”

Section: Discussionmentioning

confidence: 99%

Intestinal Transplant Registry Report: Global Activity and Trends

Grant

Abu‐Elmagd

Mazariegos

et al. 2015

American Journal of Transplantation

400

288

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“…In our patient, the findings were normal which is in accordance with a previous study. 16 Malignancies are another challenge in this patient population and several patients' contract posttransplant lymphoproliferative disorders. 5 In a recent study, the detection rate of small-bowel tumors was superior with VCE compared with other methods.…”

Section: Discussionmentioning

confidence: 99%

Initial Experience of Video Capsule Endoscopy After Intestinal Transplantation

Varkey

Oltean

Pischel

et al. 2016

Transplantation Direct

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BackgroundIntestinal transplantation is a procedure which inflicts immunological and infectious complications that affect the transplanted graft, posing both diagnostic and therapeutic challenges. Video capsule endoscopy (VCE) offers easy access to the entire small intestine and presents itself as an interesting option. However, at present, no studies evaluating the usefulness of video capsule endoscopies in this setting have been published. Our aim was to evaluate the usefulness of VCE in detecting complications that arise after intestinal transplantation.MethodsWe included 7 adult patients with either isolated intestine (n = 1) or multivisceral grafts (n = 6). These patients underwent 12 VCE between 2004 and 2015 at the Sahlgrenska University Hospital. The median age was 42 (21-67) years (4 women/3 men). VCE was used in clinical situations where the conventional diagnostic methods failed to provide answers to the clinical question.ResultsIndications for the procedure were: suspicion of rejection (n = 4 examinations), gastrointestinal dysmotility (n = 4 examinations), high stomal output (n = 2 examinations), suspicion of lymphoproliferative disease in the transplanted graft (n = 1 examination), and clinical surveillance (n = 1 examination). The median time after transplantation for performing an examination was 740 (26-3059) days. VCE was useful in 83% of the examinations and the results influenced the planned management. The overall agreement between VCE findings and biopsies was moderate (κ = 0.54, P = 0.05) but increased when comparing the presence of inflammation/rejection (κ = 0.79, P < 0.001).ConclusionsVCE is a promising diagnostic method after intestinal transplantation. However, larger studies are needed to evaluate its potential risks and gains.

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Stool Calprotectin Monitoring After Small Intestine Transplantation

Abstract: Although more frequent prospective sampling could perhaps demonstrate an advantage in early indication of rejection, based on these data, routine stool calprotectin monitoring is not strongly supported.

Cited by 29 publications

References 13 publications

Endoscopy Following Pediatric Intestinal Transplant

Endoscopy Following Pediatric Intestinal Transplant

Intestinal Transplant Registry Report: Global Activity and Trends

Initial Experience of Video Capsule Endoscopy After Intestinal Transplantation

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