A schema for histologic grading of small intestine allograft acute rejection

Wu, Tong; Abu‐Elmagd, Kareem; Bond, Geoffy; Nalesnik, Michael A.; Randhawa, Parmjeet; Demetris, Anthony J.

doi:10.1097/01.tp.0000062840.49159.2f

Cited by 188 publications

(144 citation statements)

References 9 publications

(11 reference statements)

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“…Criteria were increased crypt apoptosis and destruction, lamina propria infiltration with lymphocytes, with or without ulceration, as described previously. 12 ACR was defined as either steroid-responsive or steroid-resistant (if additional lymphocyte depletion therapy was needed).…”

Section: Human Subjectsmentioning

confidence: 99%

Increased Expression of Peripheral Blood Leukocyte Genes Implicate CD14+ Tissue Macrophages in Cellular Intestine Allograft Rejection

Ashokkumar

Ningappa

Ranganathan

et al. 2011

The American Journal of Pathology

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Recurrent rejection shortens graft survival after intestinal transplantation (ITx) in children, most of whom also experience early acute cellular rejection (rejectors). To elucidate mechanisms common to early and recurrent rejection, we used a test cohort of 20 recipients to test the hypothesis that candidate peripheral blood leukocyte genes that trigger rejection episodes would be evident late after ITx during quiescent periods in genome-wide gene expression analysis and would achieve quantitative real-time PCR replication pre-ITx (another quiescent period) and in the early post-ITx period during first rejection episodes. Eight genes were significantly up-regulated among rejectors in the late post-ITx and pre-ITx periods, compared with nonrejectors: TBX21, CCL5, GNLY, SLAMF7, TGFBR3, NKG7, SYNE1, and GK5. Only

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Section: Human Subjectsmentioning

confidence: 99%

Increased Expression of Peripheral Blood Leukocyte Genes Implicate CD14+ Tissue Macrophages in Cellular Intestine Allograft Rejection

Ashokkumar

Ningappa

Ranganathan

et al. 2011

The American Journal of Pathology

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“…ACR was classified according to standardized grading schema on a scale of indeterminate, mild, moderate and severe (Wu et al, 2003; Ruiz et al, 2004). The criteria and grading score of rejection are summarized in Table 1.…”

Section: Histopathological Examinationmentioning

confidence: 99%

Plasma citrulline levels and acute cellular rejection early after small bowel transplantation in pigs

Honsová¹,

Lodererová²,

Balaz³

et al. 2009

Vet. Med. - Czech

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Small bowel transplantations (SBT) are increasingly performed to treat patients with irreversible intestinal failure or short-bowel syndrome. Histologic evaluation of small bowel allograft biopsies is important for the diagnosis of acute cellular rejection (ACR). A reliable serological marker of ACR after SBT is still unknown. Recently, citrulline was identified as a potential biomarker of reduced enterocyte mass. The aim of our study was to analyze rejection and plasma citrulline levels early after SBT in pigs. 24 pigs were used and divided into four groups. Group A, autologous SBT (n = 3) as a control group; Group B, allogeneic SBT with tacrolimus monotherapy (n = 7); Group C, allogeneic SBT immunosuppressed with tacrolimus and sirolimus (n = 8); and Group D, without immunosuppresion (n = 6). The observation period was 30 days. Mucosal biopsies were obtained on Days 0, 3, 5, 7, 10, 14, 20, 28 and simultaneously plasma citrulline levels were measured. ACR was classified according to standardized grading schema on a scale of indeterminate, mild, moderate, and severe. There were no significant differences in citrulline plasma levels between cases with mild ACR and indeterminate for ACR. A significant decline in plasma citrulline levels occurred in cases of moderate and severe rejection. Plasma citrulline levels constituted a marker of more advanced injury of small bowel epithelium.

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“…The mucosal architecture, abnormalities of the epithelium, inflammation by either mononuclear cells and/or granulocytes, intra-epithelial lymphocytes (IEL), mucosal crypt apoptosis, and abnormalities of the vasculature were recorded for every biopsy. Acute cellular rejection was graded as suggested by Wu et al [16]. Grade 0 was normal.…”

Section: Histologymentioning

confidence: 99%

The ?Blind Innsbruck Ostomy?, a cutaneous enterostomy for long-term histologic surveillance after small bowel transplantation

Königsrainer¹,

Ladurner²,

Iannetti³

et al. 2007

Transplant Int

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Summary Intestinal transplantation has evolved into an established treatment for patients with intestinal failure. Although acute rejection episodes are reversible, late onset and chronic rejections remain major prognostic factors. We describe here our experience with endoscopic and histologic long‐term monitoring through a cutaneous enterostomy. Between 1989 and 2003, 24 intestinal transplants were performed. After revascularization and reconstruction of proximal intestinal continuity, a side‐to‐end ileo‐enterostomy was performed 20 cm from the stoma and the terminal allograft ileostomy left in the abdominal wall. Approximately after 2 months, in eight patients (nine transplants), the stoma was excluded from the gastrointestinal continuity, allowing ongoing endoscopy and histologic examination. Of 280 forceps biopsies, 64 (23%) were performed through the ‘blind ostomy’. Eleven acute allograft rejections were diagnosed between days 3 and 51, with two episodes in three cases. Through the ‘blind ostomy’, a late mild acute rejection was diagnosed in five instances, three to 37 months after transplantation. In all these patients, basal immunosuppression was intensified. Chronic rejection was seen in three cases 4–26 months after transplantation. In one of the three patients, chronic rejection was diagnosed from the excluded blind enterostomy. A long‐term cutaneous enterostomy, even if disconnected from the intestinal continuity, enables simple long‐term monitoring of small bowel allografts.

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A schema for histologic grading of small intestine allograft acute rejection

Abstract: This study provides a reliable predictive schema for assessment of the severity of human small bowel acute rejection.

Cited by 188 publications

References 9 publications

Increased Expression of Peripheral Blood Leukocyte Genes Implicate CD14+ Tissue Macrophages in Cellular Intestine Allograft Rejection

Increased Expression of Peripheral Blood Leukocyte Genes Implicate CD14+ Tissue Macrophages in Cellular Intestine Allograft Rejection

Plasma citrulline levels and acute cellular rejection early after small bowel transplantation in pigs

The ?Blind Innsbruck Ostomy?, a cutaneous enterostomy for long-term histologic surveillance after small bowel transplantation

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